September 2, 2003

To: Medicaid Provider
Office Manager

The Utah Department of Health, Division of Health Care Financing, Medicaid and Primary Care Network Program (PCN), will implement national standards for electronic health care transactions prior to October 16, 2003, as outlined in the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II).

The month prior to the October deadline, Medicaid encourages providers to intensify efforts toward achieving transaction/code set compliance. Although transaction and code set compliance is a huge undertaking, the result will greatly enhance electronic communication throughout the health care community. Successful implementation will require the attention and cooperation of Medicaid and all providers that conduct electronic transactions.

Providers submitting electronic transactions to Medicaid are required to activate a new Electronic Data Interchange (EDI) account. To activate an account, you must:

1. Be a member with Medicaid’s EDI vendor, Utah Health Information Network (UHIN) and
a. Sign the current Electronic Commerce Agreement (available at http://www.uhin.com/start/index.htm), and
b. Obtain a UHIN Trading Partner Number (TPN).
2. Submit a completed Utah Medicaid Provider EDI Enrollment application (available at http://www.health.utah.gov/hipaa/medicaid_pcn.htm).

We recognize that not all providers may be able to make the transition to the HIPAA compliant formats by October 16, 2003. Following the compliance date, Medicaid’s approach will be to utilize the flexibility granted in section 1176(b) of the Social Security Act to consider good faith efforts. Medicaid will work with providers to avoid migration from current electronic claims to paper.

Providers having difficulty preparing for electronic claims submission should contact UHIN at (801)466-7705 or Medicaid at (801)538-6155 or (800)662-9651, option 3 and 5.

BMO-355-03