EDI 5010 Testing Requirements v2.0
Test Transaction Media
Gainwell accepts batch HIPAA X12 test transaction files via Bulletin Board System know as BBS. Trading partners must test using the media you intend to use throughout your trading partner business relationship with HP. HP also provides an Internet Direct Data Entry (KY Health Net) service for individual claim transactions.
Required Test Transactions
Test files must adhere to HIPAA X12 Implementation Guide and Trading Partner Agreement constraints. The table below details the types and number of test transactions required. Billing for some *provider types requires specific examples of transactions be present to successfully test.
* The first 2 digits of the provider number indicates the provider type, if provider id begins with 71 the provider type name is listed.
| Test Transaction File Requirements |
Provider Type Submitted |
| Minimum of 10 transactions (claims), No more than 20 transactions (claims) is required of regular Medicaid billing. Claims should include valid KY Medicaid data, member id and NPI; atypical valid provider id. |
All provider types* |
| Current Service Dates (within the last 12 months) |
All provider types |
| All ALPHA characters must be in capital letters. |
All provider types |
Prior-Authorization example
All other provider types PA's are auto plugged during claim processing |
45 - EPSDT Special Services
90 - DME |
Tooth Number example
|
31 - Primary Care
35 - Rural Health (RHC)
45 - EPSDT Special Services
60/61 - Dentist Individual/Group |
Time of Pickup example
|
55 - Emergency Transportation
56 - Non -Emergency Transportation
57 - NET (Capitation)
58 - Net Clinic (Capitation) |
The minimum requirements must be achieved before a Trading Partner is granted access into the production EDI KY Medicaid BBS. The minimum requirements must be maintained throughout the EDI business relationship with KY Medicaid.
For additional information about KY Health Net click on Provider Relations link in the menu to the left and then KY Health Net user manuals.
For questions regarding test files contact the KY EDI Helpdesk at (800) 205-4696 or through email KY_EDI_Helpdesk. Monday through Friday 7am to 6pm EST.
|
kymmis > Electronic Claims > documents : Testing
