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SITEMAP

For Providers > HIPAA Transactions

For Providers - HIPAA Transactions

HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification (Title II) include provisions for an establishment of standards for electronic health care transactions and national identifiers and code sets as well as privacy of health data.

Transactions
CenCal Health is currently accepting HIPAA EDI Transactions. For any questions regarding EDI Transactions, please contact John Sanchez at 805-685-9525 x 1064 or jsanchez@cencalhealth.org to request a time slot.

When working with CenCal Health, entities will be required to review the Trading Partner Companion Guide, Questionnaire, and Agreement.

CenCal Health is currently compliant with HIPAA Transactions within limitations set by Medi-Cal's implementation of the standards and Trading Partner's readiness to submit and receive various transactions.

The transactions being implemented are currently based on the ASC X12 version 4010 Implementation Guides with October 2002 Addenda and include those transactions that will currently replace existing batch EDI forms or be used as electronic alternatives to paper forms. Although paper forms are not required to follow the HIPAA format, CenCal Health urges providers to convert from the paper to HIPAA electronic versions to improve efficiency when applicable. Additionally, providers can continue to use our website to submit claims as well as checking member eligibility (PNS).

Transactions expected to be available to providers for transmission by the deadline include:

Form	Title	Current Form(s)
837	Health Care Claim: Professional	CMS-1500 (electronic)
837	Health Care Claim: Institutional	UB-04 (electronic)
276/277	Health Care Claim Status Request and Response	Explanation of Benefits - pending (paper)
835	Health Care Claim Payment/Advice	Explanation of Benefits - paid/denied (paper)

Code Sets
CenCal Health supports National Code Sets, mandated by HIPAA, to the limit that Medi-cal only local codes are made available for use by CenCal Health's programs. As the State of California correlates its Medi-Cal only local codes to national codes, CenCal Health has implemented these changes and instructs billing providers to do the same. Please refer to Medical website, http://www.medi-cal.ca.gov, for updates.

Privacy
Please go to http://www.cencalhealth.org/for_members/index.html for information on CenCal Health's implementation of the privacy rules.