UHIN Configuration Guide v3

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Contents

Contents

Introduction

Overview

Sender and Receiver IDs

UHIN’s Payer List

Medicare ID Requirement

Generic Header

Mixed-Payer Files

Mixed Payer Header

Mixed Payer Example

Medicare Files

Medicare Example

Eligibility

Real-Time

Batch

Eligibility Header

Eligibility Example

Uploading a File

Helpful Suggestions

Contact

 

 

Introduction

This guide is a reference for Practice Management vendors and providers configuring a software product that will use a software like UHIN’s File Tool to upload transactions. Some knowledge of ANSI X12 is assumed. This is not meant to be a comprehensive guide for connecting a software directly to the UTRANSEND clearinghouse network (for those instructions, see the UTRANSEND Technical Reference Manual).

Overview

The UTRANSEND network transacts data in ASC X12 (ANSI X12) format. This guide assumes that most readers are configuring their software for insurance claims (ANSI 837) or eligibility requests (ANSI 270), and will focus on those scenarios.

To send and receive through the UTRANSEND network, the following will be required:

  • UHIN Account Number (HT#) for the provider, assigned during enrollment. See Sender and Receiver IDs.
  • Payer IDs for all desired destination payers. See UHIN’s P ayer List .
  • The software creating the files must be able to export the finished file in the ANSI X12 See Submission Options.
  • The location on the computer/network where files ready to be uploaded are stored, and their file See Uploading a File.

 

Sender and Receiver IDs

The UTRANSEND network recognizes sender and receiver IDs in the Trading Partner Number (TPN) format. These numbers are 12 characters long and are assigned to UHIN Members.

TPN Example: HT001234-001

Providers can find their TPN on the welcome materials sent via email from the UHIN Enrollment Department. Alternatively, a contact on the provider’s account can call to receive that number from UHIN Customer Service (877-693-3071).

UHIN’s Payer List

Payer Trading Partner Numbers (TPNs) and 5-digit Payer IDs can be found on UHIN’s website, at  https://uhin.org/payer-list/. The full TPN (HT00XXXX-XXX) is used to populate the header segments to facilitate routing. The most unique setup is for Medicare A or B claims. See the Medicare Example for additional information.

Otherwise, the 5-digit payer ID should ONLY be used in:

  1. Claims: Payer ID field (2010BB NM109)
  2. Eligibility Requests: Information Source Name field (2100A NM109)

For payers not on a direct connection with UHIN for eligibility, requests are routed to TransUnion. When the UHIN Payer List identifies a payer’s TPN as HT006748-300, it is an Eligibility transaction routed through TransUnion. The listed Payer ID should populate the 2100A NM109 field. For a detailed example of how to structure this kind of Eligibility request, see the Non-Direct Eligibility Example.

Medicare ID Requirement

A specific type of identifier called a Noridian Submitter ID must be included in files to Medicare Part A or Part B. Noridian Submitter IDs are 7-digits, alphanumeric, and are assigned by Noridian Medicare to identify providers. There will be one Noridian Submitter ID per provider enrolled for Electronic Data Interchange (EDI) with Medicare.

Noridian Submitter ID Example: UT12345

These IDs can be found by the provider on Noridian’s web portal, EDISS Connect (https://connect.edissweb.com/). Note that EDISS setup must be completed by the provider prior to sending Medicare A or B claims.

Once the Noridian Submitter ID has been located, it is important to send an email to UHIN at customerservice@uhin.org with that number. UHIN will enter it into a crosswalk, which will allow Medicare A and B claims to route correctly.

 

Generic Header

The example below shows the sender/receiver fields in an X12 header. There are some exceptions for Medicare Part A and B claims- see Medicare Example.

ISA06 (Interchange Sender ID) = Submitter TPN

ISA08 (Interchange Receiver ID) = Receiver TPN

GS02 (Application Sender ID) = Submitter TPN

GS03 (Application Receiver ID) = Receiver TPN

1000A NM109 = Submitter TPN

1000B NM109 = Receiver TPN

2010BB NM109 (Payer ID) = Receiver 5-Digit Payer ID

 

Mixed-Payer Files

A mixed payer file includes claims for multiple payers within the same envelope. UHIN can accommodate mixed-payer files as well as single-payer files. Use the information below to configure your claim and eligibility files as appropriate.

IMPORTANT: if you choose this option, notify UHIN at enrollment@uhin.org that you will be sending mixed-payer files. Please include your Trading Partner Number. Without this notification, your transactions may not route correctly.

Mixed Payer Header

ISA06 = Submitter Trading Partner Number

ISA08 = UHIN3

GS02 = Submitter Trading Partner Number

GS03 = UHIN3

1000A NM109 = Submitter Trading Partner Number

1000B NM109 = UHIN3

2010BB NM109 = Receiver Trading Partner Number/ 5-Digit Payer ID

 

Mixed Payer Example

If multiple destination payers are included inside the same file, use this example as a reference.

Example Submitter TPN = HT000198-010

Actual Receiver ID = UHIN3

Example Payer ID 1= HT000001-100

Example Payer ID 2= 87726

Example Payer ID 3= SX106

 

ISA*00*             *00*           *ZZ*HT000198-010  *ZZ*UHIN3   *100208*0148*^*00501*006097738*0*T*:~ GS*HC*HT000198-010*UHIN3*20100208*0149*1*X*005010X222A1~

ST*837*0001~

BHT*0019*00*HT000198-010*20100208*014900*CH~

REF*87*005010X222A1~

NM1*41*2*CLINIC ABC*HT000198-010~

PER*IC*JANE DOE*TE*8014667705~

NM1*40*2*UHIN ALL PAYERS*****46*UHIN3~

HL*1**20*1~

NM1*85*1*TEST*DOCTOR***MD*XX*1234567890~

N3*123 TESTING LANE~

N4*SLC*UT*841213592~

REF*EI*123456789~

HL*2*1*22*0~

SBR*P*18*******CI~

NM1*IL*1*SMITH*MARY****MI*A1234567890~

N3*123 ANYWHERE LANE~

N4*SLC*UT*84107~

NM1*PR*2*PAYER 1*****PI*HT000001-100~DMG*D8*19451001*M~

CLM*123SMITH*75***11::1*Y*A*Y*Y*B~

HI*BK:71891*BF:8408*BF:71941~

LX*1~

SV1*HC:97110:GP*38.26*UN*1***1:2:3~

DTP*472*D8*20130516~

SE*24*0001~

ST*837*0001~

BHT*0019*00*HT000198-010*20100208*014900*CH~ REF*87*005010X222A1~

NM1*41*2*CLINIC ABC*HT000198-010~

PER*IC*JANE DOE*TE*8014667705~

NM1*40*2*UHIN ALL PAYERS*****46*UHIN3~

HL*2**20*1~ NM1*85*1*TEST*DOCTOR***MD*XX*1234567890~

N3*123 TESTING LANE~

N4*SLC*UT*841213592~ REF*EI*123456789~

HL*2*1*22*0~ SBR*P*18*******CI~

NM1*IL*1*SMITH*JOHN****MI*A0987654321~

N3*123 ANYWHERE LANE~

NM1*PR*2*PAYER 2*****PI*87726~ CLM*123SMITHJ*75***11::1*Y*A*Y*Y*B~N4*SLC*UT*84107~

DMG*D8*19451001*M~

HI*BK:7890~

LX*1~ SV1*HC:99213*75*UN*1***1~ DTP*472*RD8*20100208-20100208~ SE*24*0001~

ST*837*0001~

BHT*0019*00*HT000198-010*20100208*014900*CH~ REF*87*005010X222A1~

NM1*41*2*CLINIC ABC*HT000198-010~

PER*IC*JANE DOE*TE*8014667705~

NM1*40*2*UHIN ALL PAYERS*****46*UHIN3~

HL*3**20*1~ NM1*85*1*TEST*DOCTOR***MD*XX*1234567890~

N3*123 TESTING LANE~

N4*SLC*UT*841213592~ REF*EI*123456789~

HL*2*1*22*0~ SBR*P*18*******CI~

NM1*IL*1*BROWN*HARRY****MI*A55566678~

N3*555 SOMEWHERE LANE~

N4*SLC*UT*84107~

NM1*PR*2*PAYER 3*****PI*SX106~ CLM*123BROWN*75***11::1*Y*A*Y*Y*B~

HI*BK:71511*BF:71951*BF:71941~DMG*D8*19451001*M~

LX*1~

SV1*HC:97110*38.26*UN*1***1:2:3~ DTP*472*D8*20130701~

SE*24*0001~

GE*1*1~

IEA*1*006097738~

 

Medicare Files

Files to Medicare Part A or Part B require special routing. Use the below information to configure files to Medicare A or B.

Medicare Example

IMPORTANT: Before sending, please notify UHIN at enrollment@uhin.org that you will be sending to Medicare Part A or Part B. Please include your Trading Partner Number and your Noridian Submitter ID. Without this notification, your transactions may not route correctly.

Example Submitter TPN = HT000198-010 Example Submitter Noridian ID = UT12345

Actual Noridian Medicare TPNs = HT000011-001 (Part A) or HT000012-001 (Part B) Actual Noridian Medicare Payer IDs = 03501 (Part A) or 03502 (Part B)

TIP:

In this example, notice that full Trading Partner Numbers (TPNs) are only used in the ISA segment. The other segments all use the Noridian Submitter ID and the Noridian Payer ID.

ISA*00*             *00*           *ZZ*HT000198-010  *ZZ*HT000012-001   *100208*0145*^*00501*006097554*0*T*:~ GS*HC*UT12345*03502*20100208*0145*1*X*005010X222A1~

ST*837*0001~

BHT*0019*00*HT000198-010*20100208*014556*CH~

REF*87*005010X222A1~

NM1*41*2*CLINIC ABC*****46*UT12345~

PER*IC*JANE DOE*TE*8014667705~

NM1*40*2*MEDICARE B NORIDIAN*****46*03502~

NM1*85*1*TEST*DOCTOR***MD*XX*1234567890~HL*1**20*1~

N3*123 TESTING LANE~

N4*SLC*UT*8412100001~

REF*EI*123456789~

HL*2*1*22*0~

SBR*P*18*******MB~

NM1*IL*1*SMITH*MARY****MI*A1234567890~

N3*123 ANYWHERE LN~

N4*SLC*UT*84107~

DMG*D8*19451001*M~

NM1*PR*2*MEDICARE B NORIDIAN*****PI*03502~

CLM*123SMITH*75***11::1*Y*A*Y*Y*B~

HI*ABK:F41~

LX*1~ SV1*HC:99213*75*UN*1***1~

DTP*472*RD8*20100208-20100208~

SE*24*0001~

GE*1*1~

IEA*1*006097554~

 

Eligibility

Real-Time

Real-time eligibility is defined as receiving a response to an eligibility request within 30 seconds on the same connection as the request. The advantage of real-time capability is the fast response for on-demand eligibility needs. Most payers support real-time eligibility.

To connect a Practice Management software for real-time eligibility, you must establish a direct connection using Webservices. SFTP is not compatible with real-time transactions. For more information about a direct Webservices or SFTP connection, see the UTRANSEND Technical Reference Manual (TRM) or, use the eligibility option in the MYUHIN portal.

 

Batch

Batch eligibility involves sending a single file containing many eligibility requests. These files are usually processed by the payers within a few hours, but may take as long as a day. The advantage of batch eligibility is the ability to send large numbers of eligibility requests automatically, without involving manual typing and sending. Most payers support batch eligibility.

To connect a Practice Management software for batch eligibility, you can either upload the transactions through the File Tool (see Uploading a File for more details), or establish a direct connection using Webservices or SFTP. For more information about a direct Webservices or SFTP connection, see the UTRANSEND Technical Reference Manual (TRM).

 

Eligibility Header

ISA06 = Submitter Trading Partner Number

ISA08 = Receiver Trading Partner Number

GS02 = Submitter Trading Partner Number

GS03 = Receiver Trading Partner Number

2100A NM109 = Receiver Trading Partner Number/ 5-Digit Payer ID

 

Eligibility Example

When sending eligibility (270/271) files, the destination payer must be individually identified as the receiver (as opposed to using the generic UHIN3 receiver for multiple payers). You can find the required IDs on the UHIN Payer List).

 

Example 1: Payer List search result

Example Submitter TPN = HT000198-010

Example Receiver TPN = HT006748-300

Example Payer ID = 10002

 

ISA*00*          *00*          *ZZ*HT000198-010   *ZZ*HT006748-300   *170917*1909*^*00501*000400000*1*P*:~

GS*HS*HT000198-010*HT006748-300*20170917*1909*407777*X*005010X279A1~

ST*270*0001*005010X279A1~

BHT*0022*13**20170917*1909~

HL*1**20*1~

NM1*PR*2*UNITED HEALTHCARE*****46*10002~

HL*2*1*21*1~

NM1*1P*2*CLINIC A*****XX*1234567890~

HL*3*2*22*0~

TRN*1*2077777701*9AAAAAAAA~

NM1*IL*1*LASTNAME*FIRSTNAME~

DMG*D8*19700101~

DTP*291*RD8*20170515-20170518~

EQ*30~

SE*13*0001~

GE*1*407777~

IEA*1*000400000~

 

Example 2: Payer List search result

Example Submitter TPN = HT000198-010

Example Receiver TPN = HT000158-001

Example Payer ID = HT000158-001

 

ISA*00*          *00*          *ZZ*HT000198-010   *ZZ*HT000158-001   *170918*0149*^*00501*000130000*0*P*:~

GS*HS*HT000198-010*HT000158-001*20170918*0149*89123*X*005010X279A1~

ST*270*0001*005010X279A1~

BHT*0022*13*1380009242048848450918004743IR*20170918*01492269~

HL*1**20*1~

NM1*PR*2*PEHP ADVANTAGE CARE-STATE OF U*****PI*HT000158-001~

HL*2*1*21*1~

NM1*80*2*CLINIC B*****XX*1098765432~

HL*3*2*22*1~

NM1*IL*1*LASTNAME*FIRSTNAME*I***MI*1000000666111~

REF*SY*555447777~

DTP*291*D8*20170918~

HL*4*3*23*0~

TRN*1*13000099999888884444*1944444057*138~

NM1*03*1*LASTNAME*CHILD*A~

REF*EJ*92220000~

REF*SY*667766777~

REF*IG*1741000000000~

DMG*D8*20000101*F~

DTP*291*D8*20170918~

EQ*86~

SE*20*0001~

GE*1*89123~

IEA*1*000130000~

 

Uploading a File

  1. First, access the UHIN File Tool via the MYUHIN portal at https://my.uhin.org. Credentials for MYUHIN were sent to the provider via secure email when enrollment was finalized.
  2. Inside MYUHIN, select UHIN File Tool in the My Apps section.
  3. You will arrive on an introduction page that explains your options and contains instructions.
    • If you would like to upload/download from a web-based interface, read through the Web Version
    • If you would prefer to download the software for a more integrated experience (Windows OS only), select Desktop Version and follow the instructions there.

 

Helpful Suggestions

In many ways, Medicare has the most stringent claim requirements. It can be helpful to look at the Medicare Companion Guide and ensure that the files created by your software would pass their requirements. This can help ensure success when claims are sent to all payers.

The Medicare Companion Guide can be found at  http://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/Downloads/5010A1837BCG.pdf.

 

Contact

For help, contact UHIN Customer Service at:

877-693-3071

customerservice@uhin.org.

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