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HIPAA Mandated Transactions
HIPAA transactions that DSS and Gainwell Technologies utilize for the Connecticut Medical Assistance Program are the:
  • ASC X12N 837 Health Care Claim Institutional Transaction - for inpatient, outpatient, home health, Part A crossover, and Part B of A crossover claims
  • ASC X12N 837 Health Care Claim Professional - for professional and Part B crossover claims
  • ASC X12N 837 Health Care Claim Dental
  • ASC X12N 835 Health Care Claim Payment/Advice - for all claim types
  • NCPDP D.0 Transaction
  • ASC X12N 270/271 Eligibility Benefit Inquiry/Response Transaction
  • ASC X12N 276/277 Claim Inquiry/Response Transaction
  • ASC X12N 278 Healthcare services Review - Requested for Review and Response
  • ASC X12N 999 Functional Acknowledgement

Frequently Asked Questions
To help you as you begin your research, Gainwell Technologies and the Department of Social Services (DSS) have compiled the following answers to frequently asked questions.
Q: I've submitted my transactions but have not received a 997 functional acknowledgement.

A: This can occur in the following situations:
  • The correct trading partner ID is not included on the ISA or GS records.
  • You have submitted transactions for which you are not authorized based on your trading partner agreement.
  • The website is slow due to the high volume of transactions being submitted.

Q: Why is the date on my 835 Remittance Advice (RA) different than my paper RA? What date should I use if I have questions or concerns?

A: The paper RA displays the date the check was issued. The electronic RA displays the date the file was created. Providers should use the date indicated on the paper RA

Q: How do I print a report using the Provider Electronic Solutions Software?

A: To print out a report after transmitting, enter the "Submit Date" (the batch number does not work). Click on Reports/Summary Forms/provider type.

Q: How do I print the report before transmitting?

A: Choose "Form Status" and click on "Ready".
For an individual client/claim- go into provider type, highlight the client, click on print.
For a detailed claim- go to Reports/ Detail Forms.

Q: Can providers assign more than one account number per client?

A: The account number can be changed for each claim, but only one account number can be entered per claim.

Q: I cannot remember my password or my password expired in the Provider Electronic Solutions software. What do I do?

A: Contact the EDI Helpdesk at 1-800-688-0503. Please have your five digit reset key number available.

Q: Once I have tested successfully, what is the next step(s)?

A: If you are using our Provider Electronic Solutions software, it is very important to know how to enter your Option tabs and change the 'Environment Ind' on the Web tab from an 'A' to a 'P' and the 'X12 Production/Test Ind' on the Carrier tab from a 'T' to a 'P.' Further instructions will be enclosed in your approval letter for production.

All other providers that use their own billing agency will receive similar instructions and letter from their billing agency to further process their claims for production.

Q: Do I have to have internet access to submit my claims?

A: Yes, internet access is required.

Q: Is there a form I can obtain to request web access for client eligibility?

A: There is no form. Only those providers who are currently active in the Connecticut Medical Assistance Program are eligible to access client eligibility. Upon enrollment in the program, providers will receive a letter with an Automated Voice Response System (AVRS) Identification Number (ID) and a Personal Identification Number (PIN). You may activate your web account by using the AVRS and PIN and gain access to client eligibility. If you have not received your AVRS and PIN information, you may contact the Provider Assistance Center to obtain a password for access at 1-800- 842-8440 (toll free).

Q: I am using your Provider Electronic Solutions software and have several billing questions regarding what value or field to key in information. What are my options?

A:Please make sure you review the Provider Electronic Solutions Billing Instructions for your appropriate provider type and the correct billing instructions. This can be found in the Trading Partner section. Provider manuals are available on our web site at on the Information/Publications page. If you still have questions after reading through your manual you may contact the Provider Assistance Center at 1-800-842-8440.

Glossary of Terms
The HIPAA Glossary gives general definitions and explanations of HIPAA-related terms and acronyms
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