New York State Department of Health (NYS DOH) - eMedNY

1 ALL SUCH. New York State Department of Health (NYS DOH). Office of Health Insurance Programs (OHIP). Standard Companion Guide Trading Partner Information Instructions related to transactions based on ASC X12 Implementation Guides, version 5010. Companion Guide Version Number: August 27, 2020. e M edN Y: TR AD IN G P AR TN ER IN FOR MA TION C O MP AN ION G UID E. Preface Companion Guides (CG) may contain two types of data, instructions for electronic communications with the publishing entity (Trading Partner Information) and supplemental information for creating transactions for the publishing entity while ensuring compliance with the associated ASC X12 Implementation Guide (IG) (Transaction Instructions).

2 Either the Trading Partner Information component or the Transaction Instruction component must be included in every CG. The components may be published as separate documents or as a single document. The Communications/Connectivity component is included in the CG when the publishing entity wants to convey the information needed to commence and maintain communication exchange. The Transaction Instruction component is included in the CG when the publishing entity wants to clarify the IG instructions for submission of specific electronic transactions . The Transaction Instruction component content is limited by ASCX12's copyrights and Fair Use statement.

3 eMedNY TPI CG Version August 27, 2020. Page 2 of 48. CONTENTS. Trading Partner Information ..6. 1. Introduction .. 6. Purpose ..6. Scope ..6. Overview ..6. References ..6. 2. Getting Started .. 8. Working Together ..8. Trading Partner Registration ..8. NYS Medicaid Program Enrollment .. 8. Requirements for Electronic Data Interchange .. 8. Supported transactions .. 10. Trading Partner Testing and Certification Process .. 11. eMedNY Provider Test Environment (PTE).. 11. PTE Enrollment and 12. PTE Access Methods .. 12. PTE Supported transactions .. 13. PTE Non-supported transactions /Activities.

4 13. PTE Availability and Submission Cutoff Times .. 13. PTE Synchronization to Production Environment .. 13. PTE Financial 14. 3. Testing and Certification 15. Testing Requirements .. 15. X12 and NCPDP Transaction Versions and Dates .. 15. PTE 15. Routing Test Files to PTE .. 16. eMedNY TPI CG Version August 27, 2020. Page 3 of 48. PTE Response File Naming Conventions .. 17. PTE Final Processing EDI Response Files .. 18. Certification Requirements .. 19. 4. Connectivity / Communications .. 21. Process Flows .. 21. ASC X12 EDI Validation (Batch File) .. 22. ASC X12 EDI Validation (Real Time).

5 23. Transmission Administrative Procedures .. 24. Re-transmission procedures .. 24. Communication Protocols .. 24. 24. eMedNY eXchange .. 25. 25. eMedNY File Transfer Service using SOAP .. 25. CORE Web Services .. 26. Security Protocols .. 27. 5. Contact information .. 27. EDI Customer Service .. 27. EDI Technical Assistance .. 27. Provider Services .. 27. Applicable websites / e-mail .. 27. 6. Control Segments / Envelopes .. 29. ISA-IEA .. 29. GS-GE .. 29. ST-SE .. 30. 7. Acknowledgements and Reports .. 30. ASC X12 Acknowledgments .. 30. Production Response Files and Naming Conventions.

6 30. eMedNY TPI CG Version August 27, 2020. Page 4 of 48. Negative Interchange Acknowledgment (TA1) or Negative File Transfer Status (F-File) .. 32. Response Specific Information .. 32. Pre-Adjudication 33. Responses to Other Batch Transaction Types .. 34. Report Inventory .. 34. Electronic Remittance Advice (ERA).. 34. Remittance Advice Format .. 35. Paper Remittance Sorts .. 35. Delivery Options for Pended Claims .. 36. Managed Care Organization Premium Payment .. 37. 8. Additional Trading Partner Information .. 37. Implementation Checklist .. 37. Trading Partner 37. Batch Transaction Size Limitations.

7 38. Frequently Asked Questions .. 38. Other Resources .. 39. Examples .. 39. Acknowledgments - Accepted .. 39. Acknowledgments - Rejected .. 40. EFT Notification Example (PTE) .. 43. Paper Remittance Example (PTE).. 44. 9. Trading Partner Information Change Summary .. 45. eMedNY TPI CG Version August 27, 2020. Page 5 of 48. Trading Partner Information 1. Introduction 0B. Purpose 9B. This document is intended to provide information from the author of this guide to trading partners to give them the information they need to exchange EDI data with the author. This includes information about registration, testing, support, and specific information about control record setup.

8 Scope 10B. This Trading Partner Information Companion Guide is intended as a resource to assist providers, clearinghouses, service bureaus, and all other trading partners of the New York State Department of Health (NYS DOH) in successfully conducting Electronic Data Interchange (EDI) of administrative Health care transactions . This document provides instructions for enrolling as a NYS DOH Trading Partner, obtaining technical assistance, initiating and maintaining connectivity, sending and receiving files, testing, and other related information. This document does not provide detailed data specifications, which are published separately by the industry committees responsible for their creation and maintenance.

9 Overview 1B. This guide provides communications-related information a Trading Partner needs to enroll as a Trading Partner, obtain support, format the ISA and GS envelopes, exchange test and production transactions with NYS DOH. Providers who are not enrolled in NYS Medicaid cannot enroll as a Trading Partner until registered and credentialed with the NYS DOH. Please visit or contact the eMedNY Call Center at: 1-800-343-9000. R eferences 12B. For billing instructions specific to practice or facility types, reference the NYS DOH. Provider Manuals posted at: Eligibility information, including Eligibility Benefits Descriptions, is published in the MEVS/DVS Provider Manual at: (.)

10 5010).pdf eMedNY TPI CG Version August 27, 2020. Page 6 of 48. Related resources such as FAQs, Crosswalks, and the complete set of eMedNY . Companion Guides are provided at: The eMedNY website also contains links to all forms and related information for enrollment as a Trading Partner of NYS DOH. The enrollment process is described in detail in the Provider Enrollment Guide: eMedNY TPI CG Version August 27, 2020. Page 7 of 48. 2. Getting Started 1B. W orking Together 13B. All eMedNY support services can be accessed through the eMedNY Call Center by calling (800) 343-9000. Technical assistance for hipaa /EDI related issues can also be obtained by emailing: Privacy Issues: Connectivity, other technical issues: T rading Partner Registration 14B.