Harvard Pilgrim Healthcare Commercial Home Health (HH), 837I 4010A1 Electronic
Harvard Pilgrim Healthcare requires sending files using a specific naming convention. There must be six parts in the file name.
Important Note: Providers must rename each file prior to sending it to Harvard Pilgrim Healthcare in the following format:
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Submitter ID – Submitter ID assigned by Harvard Pilgrim Healthcare.
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Sender ID – Submitter ID assigned by Harvard Pilgrim Healthcare.
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T or P – Either T for test files or P for production files.
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Date – Full date when the file is sent in CCYYMMDD format.
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Time – Time when the file is sent in HHMM format.
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.837 – Extension that file must have.
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For example, the file names sent on December 31, 2003 at 7:00am for a provider with the Submitter ID of 123456789 may be:
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For testing: 123456789_123456789_T_200301231_0700.837.
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For production: 123456789_123456789_P_200301231_0700.837.
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The following fields in the application are required for Harvard Pilgrim Healthcare Home Health (HH), 837I 4010A1 Electronic.
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Field
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Description
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Assignment of Benefits
and
Release of Information
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In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
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Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
-AND-
UPIN
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For each physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider taxonomy code.
The application reports the UPIN if it was entered.
These fields are located in Resource>General>Roles.
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Insurance Type Code
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Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company.
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Medicare Assign (Medicare Assignment Code)
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If any code other than A is selected, the application prints the value entered.
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Patient Sign (Patient Signature Code)
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If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500 (08/05), Block 12/13 on file).
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Program (Special Program Code)
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In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem.
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Receiver ID (File Recipient)
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Enter HPHC0001 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
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Receiver ID (Payer)
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Enter HPHC0001B in the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC.
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Receiver Name (Payer)
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Enter HPHC in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
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Submitter ID
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Enter the 8-digit alpha-numeric submitter ID in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
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Test Submission Indicator
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
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In Administration>Financial>Insurance Codes>Print Variations, select the following print variations.
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Form Locator
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Print Variation
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Printer
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HP LaserJet 4000n, driver PCL 6
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General Rules
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Make separate claims (with totals) for claims
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Suppress dots & dashes in ICD codes, dates and insured info
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Print upper case letters only
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FL 11
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Print the Insured ID
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FL 23
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Print Prior Authorization Number
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FL 24
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Print net charges on the claim
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Include separate line for each supply
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FL 27
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Put X in "Yes"
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FL 31
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Print Authorized Signature and Date
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FL 33
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Print provider number after PIN #
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Harvard Pilgrim Healthcare Home Health (HH), 837I 5010A2 Electronic
In Administration>Financial>Insurance Codes>Print Variations, select the following print variations.
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Locator
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Locator Description
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Setup
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FL 14-15
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Admission Type/Source
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Select the Print '3' and '1' Admission Type/Src print variation.
Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
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FL 18–28
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Condition Codes
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If your agency reports condition codes, enter them in Patient>General>Claim Constants.
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FL 29
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Accident State
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Enter the state in which the accident occurred in Patient>General>Claim Constants.
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FL 38
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Insurance Company Address
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Select the Print insured name & address print variation.
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FL 39–41
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Value Codes and Amount
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Enter Value Codes and the corresponding dollar amounts of the claim in Patient>General>Claim Constants.
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FL 42
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Revenue Codes
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Enter the appropriate three-digit revenue codes in Administration>Financial>Billing Rates for the insurance. Harvard Pilgrim accepts Medicare revenue codes.
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FL 45
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Service Date
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Select the Print date in MMDDYYYY format print variation.
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FL 69
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Admitting Diagnosis
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Select the Print the patient's diagnosis code as of the patient's admission date print variation.
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Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA.
Harvard Pilgrim Healthcare requires sending files using a specific naming convention. There must be six parts in the file name.
Important: Providers must rename each file prior to sending it to Harvard Pilgrim Healthcare in the following format:
|
>
|
Submitter ID – Submitter ID assigned by Harvard Pilgrim Healthcare.
|
|
>
|
Sender ID – Submitter ID assigned by Harvard Pilgrim Healthcare.
|
|
>
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Transaction Type – I for Institutional.
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>
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Date – Full date when the file is sent in CCYYMMDD format.
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>
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Time – Time when the file is sent in HHMMSS format.
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>
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.837 – Extension that file must have.
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[ISA06]_[GS02]_[I for Institutional]_[CCYYMMDD]_[HHMMSS].837
For example, HPHC9876_HPHC9876_I_20110625_123345.837.
Note: It may be necessary to go beyond Seconds in the timestamp to prevent files from overwriting during transmission. Harvard Pilgrim accepts the addition of Milliseconds to the timestamp to clarify the time of file creation later.
The following fields in the application are required for Harvard Pilgrim Healthcare Home Health (HH), 837I 5010A2 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
|
|
Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
-AND-
NPI
|
For each physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider taxonomy code.
Enter the physician's NPI.
These fields are located in Resource>General>Roles.
|
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Insurance Type Code
|
Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company.
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Medicare Assign (Medicare Assignment Code)
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If any code other than A is selected, the application prints the value entered.
|
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Patient Sign (Patient Signature Code)
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If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500 (08/05), Block 12/13 on file).
|
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Program (Special Program Code)
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In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem.
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Receiver ID (File Recipient)
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Harvard Pilgrim Healthcare supplies each submitting provider with the Submitter and Sender Identifiers for the envelope elements as a part of the setup process. The Interchange Receiver and Application Receiver IDs depend upon which
e-Channel is used.
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>
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For NEHEN and NEHENnet – Both the Interchange Receiver ID (ISA08) and Application Receiver ID (GS03) is NEHEN003.
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For non-NEHEN e-Channels – The Interchange Receiver ID (ISA08) is HPHC0001 and the Application Receiver ID (GS03) is HPHC0001B.
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Follow the non-NEHEN rules: enter HPHC0001 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
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Receiver ID (Payer)
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Harvard Pilgrim Healthcare supplies each submitting provider with the Submitter and Sender Identifiers for the envelope elements as a part of the setup process. The Interchange Receiver and Application Receiver IDs depend upon which
e-Channel is used.
|
>
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For NEHEN and NEHENnet – Both the Interchange Receiver ID (ISA08) and Application Receiver ID (GS03) is NEHEN003.
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>
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For non-NEHEN e-Channels – The Interchange Receiver ID (ISA08) is HPHC0001 and the Application Receiver ID (GS03) is HPHC0001B.
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Follow the non-NEHEN rules: enter HPHC0001B in the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC.
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Receiver Name (Payer)
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Enter HARVARD PILGRIM HEALTH CARE in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
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Submitter ID
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Enter the 8-digit alpha-numeric submitter ID in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
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Test Submission Indicator
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
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