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eMedNYHIPAASupport > Frequently Asked Questions

Frequently Asked Questions (FAQs) for eMedNY HIPAA Support

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Q.

820 and 835 Pended Claims Reports — How do these compare with the 820 and 835?

 

 

Category: Electronic Remittance

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Published: 5/27/2004

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Updated: 11/20/2015

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QID: ER01

 
 

Q.

Retros 820 - How are Retroactive Rate Adjustments reported on the 820?

 

 

Category: Electronic Remittance

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Published: 10/12/2006

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Updated: 11/20/2015

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QID: ER03

 
 

Q.

Retros 835 - How are Retroactive Rate Adjustments reported on the 835?

 

 

Category: Electronic Remittance

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Published: 10/12/2006

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Updated: 4/11/2014

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QID: ER04

 
 

Q.

Adjustments and Voids – What is the process and are there limitations?

 

 

Category: General Billing x12 claims

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Published: 10/17/2011

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Updated: 5/12/2014

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QID: GB01

 
 

Q.

Balancing in the 837 - Can you provide guidance on claim balancing?

 

 

Category: General Billing x12 claims

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Published: 10/19/2011

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Updated: 7/30/2014

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QID: GB02

 
 

Q.

COB and the CAS Segments - What is sent if the charges were not covered by the prior payer?

 

 

Category: General Billing x12 claims

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Published: 04/26/2004

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Updated: 5/12/2014

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QID: GB03

 
 

Q.

Code Checking - Can we tell if a medical or non-medical code is valid on a specific date?

 

 

Category: General Billing x12 claims

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Published: 05/26/2004

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Updated: 5/12/2014

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QID: GB04

 
 

Q.

Cost Avoidance (previously 0FILL) - What is sent for services not covered by other payers?

 

 

Category: General Billing x12 claims

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Published: 05/01/2012

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Updated: 05/12/2014

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QID: GB05

 
 

Q.

Vendor list - Does NYSDOH maintain a list of software vendors?

 

 

Category: General Billing x12 claims

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Published: 09/09/2004

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Updated: 05/12/2014

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QID: GB06

 
 

Q.

Trading Partner Agreement - Who needs to have a TPA on file?

 

 

Category: General Billing x12 claims

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Published: 09/12/2003

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Updated: 05/27/2014

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QID: GB07

 
 

Q.

Anesthesia - Claims with minutes are paid incorrectly - How should we bill our services?

 

 

Category: Professional Billing

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Published: 12/08/2003

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Updated: 03/24/2014

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QID: PB01

 
 

Q.

What are some key requirements when billing for Non-emergency Ambulette Transportation?

 

 

Category: Professional Billing

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Published: 04/24/2012

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Updated: 02/04/2014

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QID: PB02

 
 

Q.

Group ID as Billing Provider - Can a medical group be used as the Billing Provider?

 

 

Category: Professional Billing

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Published: 05/26/2004

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Updated: 06/23/2014

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QID: PB03

 
 

Q.

Orthodontics - What is the correct 837 for billing?

 

 

Category: Professional Billing

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Published: 12/29/2008

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Updated: 06/13/2014

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QID: PB05

 
 

Q.

Physician's Assistants Billing – When a Physician’s Assistant is the rendering provider, How is the 837 billed?

 

 

Category: Professional Billing

|

Published: 09/8/2006

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Updated: 06/13/2014

|

QID: PB06

 
 

Q.

Private Duty Nursing and Home Health - What is the correct 837 for billing?

 

 

Category: Professional Billing

|

Published: 05/26/2004

|

Updated: 06/13/2014

|

QID: PB07

 
 

Q.

Utilization Threshold Override - How are the Service Authorization Exception Codes used?

 

 

Category: Professional Billing

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Published: 11/11/2004

|

Updated: 06/13/2014

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QID: PB09

 
 

Q.

License Number for eMedNY - How to send a License Number as a Provider Identifier?

 

 

Category: Provider

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Published: 05/27/2004

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Updated: 05/28/2014

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QID: PR01

 
 

Q.

NPI, National Provider Identifier – I am exempt from NPI. Do I have to enter the NPI of the ordering, referring or service provider, or can I use the license number or Medicaid Provider ID?

 

 

Category: Provider

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Published: 11/03/2011

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Updated: 05/15/2014

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QID: PR02

 
 

Q.

Facilities Practitioner’s NPI Reporting Frequently Asked Questions

 

 

Category: Provider

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Published: 05/27/2004

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Updated: 05/15/2014

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QID: PR03

 
 

Q.

NPI, National Provider Identifier – When I enrolled as a sole practitioner, I was given a single MMIS Provider ID to use for my corporate entity and as an individual. Now I have an individual NPI and an organization NPI. How should I register the two NPIs?

 

 

Category: Provider

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Published: 07/14/2008

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Updated: 05/15/2014

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QID: PR04

 
 

Q.

NPI, National Provider Identifier – How can I tell if I need to get an NPI for NYS Medicaid billing?

 

 

Category: Provider

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Published: 11/03/2011

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Updated: 05/27/2014

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QID: PR05

 
 

Q.

APG - How do I bill an APG claim versus another Institutional claim?

 

 

Category: Institutional Billing

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Published: 7/15/2008

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Updated: 05/27/2014

|

QID: IB01

 
 

Q.

Bus Token Reimbursement - Is there a way to bill for NYS Medicaid clinic patients?

 

 

Category: Institutional Billing

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Published: 05/26/2004

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Updated: 05/27/2014

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QID: IB02

 
 

Q.

Covered Days – How are Covered Days reported on the 837I?

 

 

Category: Institutional Billing

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Published: 07/20/2012

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Updated: 05/27/2014

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QID: IB03

 
 

Q.

Dental Clinic, Facility Code, Product/Service ID field - What goes in CLM05 and SV201?

 

 

Category: Institutional Billing

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Published: 10/21/2011

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Updated: 05/27/2011

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QID: IB04

 
 

Q.

Discharged Patient to Hospital - What is required when billing on the 837 Institutional?

 

 

Category: Institutional Billing

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Published: 05/26/2004

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Updated: 05/27/2014

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QID: IB05

 
 

Q.

ICD-9 Procedure Codes - Can they be used for Hospital Outpatient Claims at claim level?

 

 

Category: Institutional Billing

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Published: 12/10/2003

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Updated: 10/9/2014

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QID: IB06

 
 

Q.

Graduate Medical Education (GME) – How do I bill this type of claim?

 

 

Category: Institutional Billing

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Published: 10/26/2011

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Updated: 05/27/2014

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QID: IB07

 
 

Q.

Methadone Maintenance – Why must these be billed with a Sunday date of service?

 

 

Category: Institutional Billing

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Published: 10/26/2011

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Updated: 05/27/2014

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QID: IB08

 
 

Q.

Net Available Monthly Income (NAMI) - What are the reporting requirements for Long Term Care (LTC)?

 

 

Category: Institutional Billing

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Published: 05/26/2004

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Updated: 05/27/2014

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QID: IB09

 
 

Q.

Newborn Hearing Screening - How should we bill for this service?

 

 

Category: Institutional Billing

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Published: 03/02/2005

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Updated: 05/27/2014

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QID: IB10

 
 

Q.

Newborn Hearing Screening - How should we bill for this service?

 

 

Category: Institutional Billing

|

Published: 5/21/2007

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Updated: 06/20/2014

|

QID: IB11

 
 

Q.

Orthodontics - What is the correct 837 for billing?

 

 

Category: Institutional Billing

|

Published: 12/29/2008

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Updated: 5/29/2014

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QID: IB13

 
 

Q.

Premium Billing - How should a Managed Care Plan submit a HIPAA 837I for premium billing?

 

 

Category: Institutional Billing

|

Published: 11/04/2011

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Updated: 5/29/2014

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QID: IB14

 
 

Q.

Private Duty Nursing and Home Health - What is the correct 837 for billing?

 

 

Category: Institutional Billing

|

Published: 05/26/2004

|

Updated: 5/29/2014

|

QID: IB15

 
 

Q.

Rate Codes - How should rate-based claims, including multiple rates, be submitted?

 

 

Category: Institutional Billing

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Published: 11/10/2010

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Updated: 5/29/2014

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QID: IB17

 
 

Q.

Rate-based claims with multiple dates or units - How are units billed?

 

 

Category: Institutional Billing

|

Published: 10/25/2011

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Updated: 6/20/2014

|

QID: IB18

 
 

Q.

Residential Treatment Days - How should Inpatient (Title XIX) Days be reported?

 

 

Category: Institutional Billing

|

Published: 05/26/2004

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Updated: 5/29/2014

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QID: IB19

 
 

Q.

Utilization Threshold Override - How are the Service Authorization Exception Codes used?

 

 

Category: Institutional Billing

|

Published: 11/11/2004

|

Updated: 6/20/2014

|

QID: IB20

 
 

Q.

Value Information - How can several Value Code amounts be reported on one claim?

 

 

Category: Institutional Billing

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Published: 11/20/2006

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Updated: 5/29/2014

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QID: IB21

 
 

Q.

Diagnosis Related Group (DRG/APRDRG) claims – What are the billing procedures for DRG claims and DRG with Alternate Level of Care?

 

 

Category: Institutional Billing

|

Published: 10/21/2011

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Updated: 5/29/2014

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QID: IB22

 
 

Q.

Coverage and Claims Questions - Who do I contact if I have coverage or claim questions?

 

 

Category: Eligibility

|

Published: 10/20/2011

|

Updated: 5/15/2014

|

QID: EL01

 
 

Q.

Eligibility– What search criteria does eMedNY support for Eligibility Inquiry (ASC X12N 270)?

 

 

Category: Eligibility

|

Published: 01/23/2013

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Updated: 11/13/2015

|

QID: EL02

 
 

Q.

HIPAA Information - Where are the Implementation Guides, Code Sets, and Rules?

 

 

Category: eMedNY Processing

|

Published: 05/27/2004

|

Updated: 6/13/2014

|

QID: CP01

 
 

Q.

Cycle – What is the Claims Cycle?

 

 

Category: eMedNY Processing

|

Published: 05/26/2004

|

Updated: 08/12/2015

|

QID: CP02

 
 

Q.

Data Security - What steps should you take in securing your data?

 

 

Category: eMedNY Processing

|

Published: 11/05/2003

|

Updated: 05/15/2014

|

QID: CP03

 
 

Q.

Implementation Acknowledgment - When will I receive a 999 transaction?

 

 

Category: eMedNY Processing

|

Published: 10/24/2011

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Updated: 05/27/2014

|

QID: CP04

 
 

Q.

Implementation Acknowledgment Rejection - How do I identify exactly where an error occurred?

 

 

Category: eMedNY Processing

|

Published: 10/25/2011

|

Updated: 05/27/2014

|

QID: CP05

 
 

Q.

Invalid Character errors - How can we clear these up?

 

 

Category: eMedNY Processing

|

Published: 05/26/2004

|

Updated: 5/29/2014

|

QID: CP06

 
 

Q.

Response Files - What Are the Response Files Sent By eMedNY?

 

 

Category: eMedNY Processing

|

Published: 09/13/2011

|

Updated: 06/13/2014

|

QID: CP07

 
 

Q.

Response Timeframe - What is the response time for Claim Status Inquiry and Response?

 

 

Category: eMedNY Processing

|

Published: 12/18/2003

|

Updated: 06/13/2014

|

QID: CP08

 
 

Q.

Recycled Pends – How are they reported? Can I establish the manner in which I receive them?

 

 

Category: eMedNY Processing

|

Published: 11/09/2007

|

Updated: 05/27/2014

|

QID: CP09

 
 

Q.

TCN - How is the Transaction Control Number generated?

 

 

Category: eMedNY Processing

|

Published: 11/11/2011

|

Updated: 12/18/2013

|

QID: CP10

 
 

Q.

Receiver Name Segment - What identifiers go in the Receiver Name loop NM1 segment?

 

 

Category: eMedNY Processing

|

Published: 05/27/2004

|

Updated: 05/27/2014

|

QID: CP12

 
 

Q.

Receiving Invalid File Format Message - What causes this?

 

 

Category: eMedNY Processing

|

Published: 05/27/2004

|

Updated: 11/17/2015

|

QID: CP13

 
 

Q.

Transaction Limits - How many ST/SE loops may be contained within an ISA/IEA?

 

 

Category: eMedNY Processing

|

Published: 11/11/2011

|

Updated: 05/27/2014

|

QID: CP14

 
 

Q.

Group ID as Billing Provider - Can a medical group be used as the Billing Provider?

 

 

Category: Dental Billing

|

Published: 05/26/2004

|

Updated: 11/18/2015

|

QID: DB02

 
 

Q.

Utilization Threshold Override - How are the Service Authorization Exception Codes used?

 

 

Category: Dental Billing

|

Published: 11/11/2004

|

Updated: 06/13/2014

|

QID: DB05

 
 

Q.

How do software vendors test for compliance with eMedNY?

 

 

Category: Testing

|

Published: 01/09/2004

|

Updated: 05/27/2014

|

QID: TS01

 
 

Q.

Provider Test Environment (PTE) – What are the processing and cycle cutoff times for test claim submissions?

 

 

Category: Testing

|

Published: 09/25/2010

|

Updated: 07/22/2016

|

QID: TS02

 
 
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