eMedNYHIPAASupport

eMedNY's Headquarters for HIPAA X12 5010/NCPDP D.0

When entering this site, be sure to review eMedNYHIPAASupport What's New for the latest changes.

Important Announcements

August 1, 2024

An updated version of the eMedNY MCE 834 Companion Guide (version 3.3) is published on the eMedNYHIPAASupport page. Enhancements planned with this release (September 26, 2024) will allow eMedNY to share Medicare Savings Plan (MSP) Information on all MCE 834 transaction types. For translation recommendations and examples refer to the new MSP Information section of the MCE 834 Companion Guide (CG).

All sample transactions within the MCE 834 CG are also updated and can be used by the Plans for internal testing. eMedNY will NOT send any test files directly to Plans as part of this update. Text versions of all samples included in this MCE 834 CG are also available for download from the eMedNYHIPAASupport Transaction Instructions page.

MCE CG Sample Test Files

Managed Care Plans are encouraged to review the updated guidance and begin preparing for upcoming changes outlined within these supporting documents.For HIPAA/EDI related issues or concerns related to Companion Guide updates, email eMedNYHIPAASupport@GDIT.com

March 29, 2024

An updated version of the eMedNY Transaction Information Standard Companion Guide CAQH - CORE CG X12 (version 5.0) is published on the eMedNYHIPAASupport page. Changes with this release are as follows:

Added Value Code 85 for FIPS to HI segment in the 837I

Removed all reference to FTP – FTP was shut down on 11/1/2023

Other Revisions:

Formatting, spelling, punctuation and grammar corrections
Removed Password section – redundancy – passwords are addressed in each application manual that uses a password
Removed all reference to MEDS History – obsolete
Removed all reference to Family Health Plus (FHP) – obsolete program
Clarified the "W" entries in EB01 sections of the 271
Clarified Service Authorization codes in Loop ID 2300 REF02 in the 837I, 837P, 837D
Corrected MMIS ID example in Loop ID 2010BB in the 837I, 837P, 837D
Clarified some acronyms throughout
Normalized formatting of phone numbers
Loop naming conventions changed to match X12 IP requirements (loop to Loop ID)
Corrected outdated, broken, or obsolete links
Edited sections for clarity/redundancy: Communication Protocol Specifications; Business Scenarios in Appendix 2; eMedNY eXchange, Other Useful Websites
Highlighted (bolded) significant changes in this change log from beginning to current
Updated dates in samples/examples

December 5, 2023

An updated version of the eMedNY MCE 834 Companion Guide (version 3.2) is published on the eMedNYHIPAASupport page. Changes being planned with this release includes updates to multiple Code Lists, including the RRE Code, Aid Category Codes and COE codes. These new codes, resulting from multiple projects, will be promoted over the next few months, starting January 1, 2024 through Spring 2024. For specifics refer to the TI Change Summary Section of the MCE 834 CG.

eMedNY MCE 834 Companion Guide

Managed Care Plans are encouraged to review the updated guidance and begin preparing for these changes outlined for the MCE 834 transaction set.

March 21, 2023

An updated version of the eMedNY MCE 834 Companion Guide (version 3.1) is published on the eMedNYHIPAASupport page. Changes being planned with this release includes updates to multiple Code Lists, including the RRE Codes, Aid Category Code and COE codes. These new codes, resulting from multiple projects, will be promoted over the next six months, starting April 20, 2023 through fall 2023. For specific release dates, refer to the TI Change Summary Section of the MCE 834 CG.

eMedNY MCE 834 Companion Guide

Managed Care Plans are encouraged to review the updated guidance and begin preparing for these changes outlined for the MCE 834 transaction set.

September 9, 2022

An updated version of the eMedNY MCE 834 Companion Guide (version 3.0) is published on the eMedNYHIPAASupport page. Changes being planned with this release (October 27, 2022) includes updated Race and Ethnicity Codes.

Currently, eMedNY shares the Race and Ethnicity information for WMS members using a limited set of codes from the 834 TR3 internal code list for DMG05-1. With this release, eMedNY will transition to an expanded set of standardized codes, by using the components DMG05-2 and DMG05-3, to share Race and Ethnicity Information for WMS Members. For detailed information, refer to the updated Code List in the MCE 834 CG.

All sample transactions within the Companion Guide are updated and can be used by the Plans for internal testing. eMedNY will NOT send any test files directly to Plans as part of this update. Text versions of all samples included in this Companion Guide are also available for download from the eMedNYHIPAASupport Transaction Instructions page. Look for these MCE 834 CG Sample Files under Managed Care Enrollment and select appropriate CG Samples.

www.emedny.org/HIPAA/5010/transactions/

Managed Care Plans are encouraged to review the updated guidance and begin preparing for these changes outlined for the MCE 834 transaction set.

April 26, 2022

An updated version of the eMedNY MCE 834 Companion Guide (version 2.9) is published on the eMedNYHIPAASupport page. Changes being planned with this release (May 26, 2022) focus primarily on sharing the Rate Code Begin Date with the Plans.

Currently, eMedNY includes the active Rate Code on member file within Loop 2750 under a Reporting Category MED RATE CODE. With this release, eMedNY will also include the Rate Code Begin Date on the 834 transaction within Loop 2750 DTP Segment.

https://www.emedny.org/HIPAA/5010/transactions/index.aspx

This CG revision also includes modification to the Code List for RRE Codes and updates to the Verification (Audit) File paragraph. Refer to the TI Change Summary, in the published CG, for a complete list of modification. Managed Care Plans are encourage to review the updated guidance and begin preparing for these changes outlined for the MCE 834 transaction set.

December 17, 2021

An updated version of the eMedNY MCE 834 Companion Guide (version 2.8) is published on the eMedNYHIPAASupport page. Changes being planned with this release (January 27, 2022) focus primarily on the eMedNY File Naming Conventions to incorporate the 8-digit MMIS Provider ID within the second node of the X12 834 file name.

This CG revision also includes modifications to the Notes related to Recertification Dates, Data Element HD04 and the COB Segment. The Code Lists for RRE Codes and Coverage Codes are also being updated.

Refer to the TI Change Summary, in the published CG, for a complete list of modification. Managed Care Plans are encourage to review the updated guidance and begin preparing for these changes outlined for the MCE 834 transaction set.

August 23, 2021

An updated version of the eMedNY MCE 834 Companion Guide (version 2.7) is published on the eMedNYHIPAASupport page. Changes being planned with this release (October 22, 2021) focus primarily on the Recipient Restriction Exception (RRE) Information shared with the Plans.

https://www.emedny.org/HIPAA/5010/transactions/index.aspx

This release will also include a change to the DMG segment (Loop 2100A). Starting on October 22, 2021, eMedNY will no longer omit the DMG Segment (Loop 2100A) when there are no demographics changes on a CHANGE transaction.

June 9, 2021

An updated version of the eMedNY MCE 834 Companion Guide (version 2.6) is published on the eMedNYHIPAASupport page. Substantial changes are being planned for this release, which include modifications to multiple Loops/Segments, addition of new reason codes, and a new sample transaction to aid in internal testing. Refer to the TI Change Summary, in the published CG, for a complete list of modification. Managed Care Plans are encourage to review the updated guidance and begin preparing for these changes outlined for the MCE 834 transaction set.

About eMedNYHIPAASupport

NYS Medicaid is dedicated to providing pertinent information relating to the New York State Medicaid program. All health care providers are required to submit claims electronically. This includes all health plans including private and government programs, and health care clearinghouses. We urge the health care community to become familiar with the requirements affecting eMedNY.

This site has been created for the provider community, and will be used by the NYS Medicaid program as a main source for dissemination of information and notification of all New York State Medicaid activities. This site will be updated on a regular basis in an effort to share relevant Medicaid information, its potential impact on our program and its potential impact on providers' business processes and information system. Whenever entering this site, be sure to check out our Frequently Asked Questions (FAQ's) section. We have already posted answers to many of your most common and problematic questions. We will be continuing to post new questions and answers as they arise.