Gainwell Technologies provides free software called Provider Electronic Solutions (PES) for the submission of eligibility verification and claim transactions.

Important: The upgrade to the 3.81 version will remove the Professional, Dental, Inpatient, Outpatient/Home Health claim submission transactions as well as the claim status request transaction. Providers who still use these transactions are encouraged to migrate to another claims submission/claim status tool before these transactions will no longer be accepted via PES in the fall of 2015. The latest version is available in the table below. Please review the download instructions as well as the installation instructions prior to proceeding.

Provider Type	Provider Electronic Solutions Full Install	Provider Electronic Solutions Upgrade
All Providers	Instructions for downloading Full Version of Provider Electronic Solutions 3.81 Download version 3.81 for initial installation.	Download 3.81 upgrade (Newest upgrade) Note: You must be running version 3.80 prior to applying this upgrade. Warning: The 3.81 upgrade will remove the Professional, Dental, Inpatient, Outpatient/Home Health claim submission transactions and the claim status request transaction. Upgrade instructions via the Web. OR Upgrade Instructions via Provider Electronic Solutions Provider Electronic Solutions 3.81 Upgrade Provider Electronic Solutions 3.80 Upgrade
Provider Electronic Software Material	PES Handbook How to set up options tab: Acceptance Production	How to read a 999

The following documents are pertinent to all who will be billing electronically in the HIPAA compliant transaction formats:

Implementation Guides - The ASC X12N and NCPDP implementation guides have been established as the standards for HIPAA compliance.

Companion Guide - The Connecticut Department of Social Services (DSS) and its fiscal agent, Gainwell Technologies are responsible for processing electronic transactions for the Connecticut Medical Assistance Program. The Companion Guide, 270/271 Companion Guide, 276/277 Companion Guide, and Safe Harbor Companion Guide provide trading partners with documents that communicates the Connecticut Medical Assistance Program specific information required to successfully exchange transactions electronically with Gainwell Technologies in ASC X12 and NCPDP D.0 standard formats. The information contained in these manuals is for both billing providers and technical staff. Electronic submitters should use the Implementation Guides and Companion Guide for format and code set information. Electronic submitters should use Chapter 8 of the Provider Manual for Connecticut Medical Assistance Program claim submission instructions and policy guidelines.

Vendor Interface Specifications This document is intended for software vendors to use in order to develop applications to interact with the Connecticut Medical Assistance Program system and upload and download HIPAA compliant transactions. The Connecticut Medical Assistance Program currently supports a web based and a dial up connection. To obtain information regarding the telecommunication requirements, please download the Vendor Interface Specification document.

All newly enrolling entities must complete and submit an online Trading Partner Agreement in order to bill electronically:

Electronic Remittance Advice Specifications - The ASC X12N 835 (005010X091) Health Care Payment/Advice transaction. The Implementation Guide can be found on www.wpc-edi.com and may be downloaded for your convenience. The Implementation Guide is designed to assist Trading Partners who submit claims and/or receive Electronic Remittance Advice (ERA) in the 835 format. If you would like to download the 835, please make sure to update your Trading Partner Agreement to include the 835 transaction.

All providers will have the paper remittance advice (RA) available for download in a PDF format on the secure site by accessing Trade Files-Download.

Claim Transactions - Providers must transmit claims through the secure Web site using the HIPAA compliant NCPDP and ASCX12N Health Care Claim transaction format. Providers or their Billing Agents will be required to complete an on line Electronic Data Interchange Trading Partner Agreement form and successfully complete a test using the ASC X12N 837 Health Care Claim format appropriate to their provider type. Providers or Billing Agents should download the necessary Trading Partner Agreement, Companion Guide and/or Safe Harbor Companion Guide for more detailed information.

Once a Trading Partner Agreement form has been completed online you will receive a Trading Partner ID and Personal Identification Number (PIN) with instructions for setting up your Trading Partner Secure Web account. Trading Partners will then use their new Secure Web account to submit a Test file via the Secure Web site. Note that all new Trading Partners must complete their initial test file submission(s) through the Secure Web site as described below. CAQH-CORE Safe Harbor submissions are only available to Trading Partners who have been approved to submit and receive Production transactions to Connecticut Medicaid.

Eligibility Inquiry, Claim Status Inquiry and Claim Payment/Advice - Providers or their Billing Agents must transmit Inquiry transactions and retrieve files through the Gainwell Technologies secure Web site or the Safe Harbor connection using the HIPAA compliant ASCX12N transaction format. Providers or their Billing Agents will be required to complete an on line Electronic Data Interchange Trading Partner Agreement form or mail a completed Trading Partner Agreement form and successfully complete a test using the ASC X12N transaction format appropriate to their selected transaction. Users should download the necessary Trading Partner Agreement, Companion Guide and/or Safe Harbor Companion Guide for more detailed information.

Once a Trading Partner Agreement has been completed online you will receive a Trading Partner ID and Personal Identification Number (PIN) with instructions for setting up your Trading Partner Secure Web account. Trading Partners will then use their new Secure Web account to submit a Test file via the Secure Web site. Note that all new Trading Partners must complete their initial test file submission(s) through the Secure Web site as described below. CAQH-CORE Safe Harbor submissions are only available to Trading Partners who have been approved to submit and receive Production transactions to Connecticut Medicaid.

Test Transactions - Trading Partners must submit test transactions for all inbound HIPAA file types they will be submitting to Gainwell Technologies for Connecticut Medicaid via the Secure Web Portal. Upon submission of an accepted transaction, the resulting 999 Implementation Acknowledgement response file should be downloaded and faxed to 1-877-413-4421 Attention: EDI TPA. The fax must also contain the file tracking number, the type of transaction that was submitted, and the Trading Partner ID. This process must be repeated for each type of transaction that the Trading Partner will be submitting to Gainwell Technologies. After Gainwell Technologies receives and processes the testing result fax, the Trading Partner will receive a letter notifying them of their production status. Until this notice is received and the Trading Partner changes their transaction Usage indicator (ISA15) from T to P, the transaction will not be processed by Gainwell Technologies. Unsolicited Outbound HIPAA transactions, such as the 835, are excluded from the testing requirement.

Electronic Remittance Advice Transactions - Trading Partners can receive electronic remittance advices through Gainwell Technologies' Secure Web portal or the Safe Harbor connection using the HIPAA compliant ASC X12N 835 Payment/Advice transaction. Providers or their Billing Agents are required to complete a Trading Partner Agreement form as previously described. Users can access the necessary information and forms online, located in the Trading Partner Agreement section. Note that each Provider Service Location (as identified by CT Medicaid AVR ID) must be entered in the Electronic Remittance Advice section of the online Trading Partner Agreement, or in Article VIII of the paper Trading Partner Agreement, in order to generate an 835 which contains the Provider claim payment and adjudication information. Trading Partners who will use the Safe Harbor connection to retrieve the 835 must ensure that at least one of their associated Provider Electronic Remittance Advice records has “Safe Harbor” selected in the “Method of Retrieval” field. The Secure Web portal will continue to have your 835 files available for download even when the Safe Harbor Method of Retrieval is selected.

Once you have completed the on line Trading Partner Agreement form, you will receive a Trading Partner ID and Personal Identification Number (PIN) with instructions for setting up your Trading Partner Secure Web account. Trading Partners will then use their new Secure Web account to access their 835 which will be available for download after the next financial cycle. Once you have accessed your first file, you will need to confirm that you are able to read the information on the file.