Moda Health HIPAA AND CODE SETS: May 2012
| Transaction | Transaction# | Production |
|---|---|---|
| All implementations are the Addenda version | ||
| Professional claim/encounter | 837P | Batch |
| Dental claim/encounter | 837D | Batch |
| Institutional claim/encounter | 837I | Batch |
| Eligibility request/response | 270/271 | Real time/Batch |
| Claim status request/response | 276/277 | Real time/Batch |
| Group enrollment | 834 | Batch |
| Group premium | 820 | Batch |
| Healthcare services request/response | 278 | Batch |
| Electronic remittance advice and EFT | 835 | Batch |
| Topic | Regulation date | Effective (Implementation) Date |
|---|---|---|
| Operating rules for eligibility and claim status | July 1, 2011 | Jan. 1, 2013 |
| IFR - Operating rules for remittance advice and EFT | 01/2012 | Jan. 1, 2014 |
| Operating rules for claims, enrollment and disenrollment, premium payments and referrals | July 1, 2014 | Jan. 1, 2016 |
| Final rule for Unique Health Plan Identifier | 07/2012 | TBD |
| Standard for electronic funds transfer | Jan. 1, 2012 | Jan. 1, 2014 (same date for operating rule) |
| Standard and operating rules for claims attachment | Jan. 1, 2014 | Jan. 1, 2016 |
| Health plans file statement that their systems are in compliance with standards and operating rules for EFT, eligibility, claims, status, and payment and remittance advice. | Dec. 31, 2013 |
National identifiers
Employer ID
- May 31, 2002 — Final rule announced
- July 31, 2004 — Compliance date for large plans
- July 31, 2005 — Compliance date for small plans
Provider ID
- Jan. 23, 2004 — Final rule announced
- May 23, 2008 — Compliance date for small plans
- Applying for a NPI
- Frequently asked questions
- Moda Health information specific for dentists applying for an NPI
- Moda Health information specific to medical providers and health systems applying for an NPI
Payer ID
- To be determined — Date not yet announced
- Notice of Proposed Rule Making (NPRM) expected in 2012
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Hello.
We have exciting news to share. ODS is changing its name to Moda Health.
Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.
Together, we can be more, be better.
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