Transactions & Code Sets is concerned with the electronic exchange of data between providers, health plans, clearinghouses and other health care business associates. The HIPAA national standards for health related transactions will enable electronic information to be sent and received more effectively. Some examples are the use of standard claim data by all insurers and the assignment of national identification numbers for providers that will be used by all insurers. Health plans must accept and return all data required by these standards and cannot request or return data not specified by the national standards.

Uniprise conducts the following transactions for which a national standard has been adopted:

• Professional claims and institutional claims
• Eligibility (inquiry & response)
• Claim status (request & response)
• Enrollment and disenrollment
• Claim payment and remittance advice
• Premium payments
• Referral, certification and authorization (request and response)

Uniprise implemented the HIPAA standards for these transactions in October, 2002. When these standards were updated in early 2003, Uniprise implemented the revisions (“Addenda A1”). Since then, we have been helping our submitters convert to the standard transactions.

We require our business partners to test with us before converting to the HIPAA standard transactions. If submissions are made to a clearinghouse, testing should be arranged with the clearinghouse. Entities that submit directly to us, have been contacted to arrange testing.