HFS has provided the Internet Electronic Claims (IEC) System to handle the electronic transfer of HIPAA-compliant formats, to meet the requirements of HIPAA.
If you are unsure whether you will have access to the IEC System, review the Application Access topic for more information on what is available to the different business types.
In the IEC System, each business type (e.g. provider, payee, payor or other business) will have access to different HIPAA transactions depending on the following rules:
Provider access is based on its provider type.
Payees have access to retrieve remittance advices and submit acknowledgments.
Payees may also request authorization from a provider(s); and the provider administrator may grant authorization. Payees cannot request authorization from a payor.
Payors have access to check eligibility and to submit claims. Payors will also have the ability to receive a proprietary remittance advice file.
Other business types must request authorization from a provider(s) or payor(s); and the provider or payor administrator may grant authorization. Other business authorization has specific registration requirements depending on the type of authorization needed. Review the specific requirements for Other Business registration in the Business Rules section of the Other Business Registration Page.
The IEC System has limitations on what payee and other business types have access to on behalf of Medicaid providers and payors. HFS requires that providers and payors authorize at a transaction level for the IEC System. It is up to the provider or payor administrator to grant access to the individual transactions. Check the HIPAA Transactions Provider Type Cross Reference for a list of transactions available for each provider type. Check the Payor Application Access and HIPAA Cross Reference for a list of transactions available for a payor.
In addition, the Current HIPAA Transaction Set topic provides information on the implementation level and specific X12N transactions the IEC System will support. Check the IEC System Home page for more information on which transaction have actually been implemented.
Note: If registered in the Provider, Payor or Payee category, the business should be able to submit/receive HIPAA-compliant transmissions within 24 hours of its registration. If a business administrator for a payee or other business type has requested authorization from a provider or payor, the business will be able to submit/receive HIPAA-compliant transmissions for the provider or payor within 24 hours of receiving the provider's or payor's authorization. This is required in order to update HFS's X12N translator software.
You may review the topics below for more information on the specific transactions providers, payors, payees and other authorized businesses can submit and receive.
HIPAA Transactions Provider Type Cross Reference
Payee Application Access and HIPAA Cross Reference