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Moda Health HIPAA AND CODE SETS: May 2012

Version 5010
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

 

Federal timelines — general information (dates are subject to change)
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

 

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

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