HIPAA/EDI

Significa Benefit Services is committed to complying with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The information below reflects our current compliance status in relation to the standard EDI transaction sets. Please feel free to contact our office if additional information is required. Employers are subject to the HIPAA Privacy Rule.

Application Software

Because Significa Benefit Services maintains a staff of in-house programmers, we are able to enhance our application software as needed. The vendor of our application software, United Systems and Software, Inc., has developed an add-on package for translation of EDI transactions into or from the claims administration application.

Transaction Sets

ASC X12N 837 Health Care Claim: Professional
We currently accept these transactions through Change Healthcare. Our payer ID is 23250. Additional options are available for our PPO partners.

ASC X12N 837 Health Care Claim: Institutional
We currently accept these transactions through Change Healthcare. Our payer ID is 23250. Additional options are available for our PPO partners.

ASC X12N 837 Health Care Claim: Dental
We currently accept these transactions through Change Healthcare. Our payer ID is CX046.

ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response
We currently accept 270 Eligibility Benefit Inquiry transactions and provide 271 Eligibility Benefit Response transactions via Change Healthcare Realtime Transaction processing.

ASC X12N 278 - Health Care Services Review
Based on the implementation guide for this transaction set, only UMOs are required to receive this information.

ASC X12N 276/277 Health Care Claim Status Request and Response
We currently accept 276 Claim Status Request transactions and provide 277 Claim Status Response transactions via Change Healthcare Realtime Transaction processing. In addition, we are able to provide 277 Unsolicited Claim Status in response to Health Care Claim transactions received in batch mode.

ASC X12N 834 - Benefit Enrollment and Maintenance
We offer X.12 834 transactions for eligibility downloads to our PPO partners upon request. Our self-funded clients can currently enroll new employees and submit termination requests to us via our secured Employer website.

ASC X12N 835 - Health Care Claim Payment/Advice
We offer X.12 835 ERA transactions with ACH payment through Change Healthcare. Please enroll with Change Healthcare at http://www.echohealthinc.com/. Additional options are available through our PPO partners.

Code Sets

ICD-10-CM Volumes 1, 2 and 3
We currently use this code set as required.

Code on Dental Procedures and Nomenclature
We currently use this code set as required.

Health Care Financing Administration Common Procedure Coding System (HCPCS)
We currently use this code set as required.

Current Procedural Terminology (CPT-4)
We currently use this code set as required.

Links to Non-Significa Benefit Services Web Sites
Links are provided within our web site to non-Significa Benefit Services web sites. By supplying a link to these web sites, Significa Benefit Services does not endorse these web sites nor are we responsible for their privacy policies or content. Concerns should be directed to the owner of these web sites. We review these links periodically to ensure that they are valid.