Companion Document Audience
Companion documents are intended for information technology and/or
systems staff who will be coding billing systems or software for
compliance with the federal Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
Purpose of Companion Documents
The information contained in this companion document applies to
Wisconsin Chronic Disease Program (WCDP).
The companion documents are designed to be used with HIPAA
Implementation Guides. Companion documents provide WCDP specific
information that details the way to create HIPAA transactions for WCDP and
explains how WCDP creates HIPAA transactions. Companion documents clarify
the HIPAA-designated standards usage but are not intended to supercede
them. The purpose of companion documents is to provide trading partners
with a guide to communicate the WCDP specific information required to
successfully exchange transactions electronically with WCDP.
Wisconsin Medicaid will accept and transfer HIPAA-compliant NCPDP 5.1
transactions to WCDP for processing. However, all WCDP pharmacy claim
adjustments must be submitted on paper. Also, a compliant transaction that
doesn’t contain WCDP-specific information, though processed, may be
denied for payment. For example, a compliant 837 claim created without a
WCDP client identification number will be processed by WCDP, but will be
denied payment.
Companion documents highlight the data elements significant for WCDP.
For transactions created by WCDP, companion documents explain how certain
data elements are processed. Please refer to the companion document first
if there is a question about how WCDP processes a HIPAA transaction. For
further information, contact the Division of Health Care Financing (DHCF)
Electronic Data Interchange (EDI) Department at (608) 221-9036.
TABLE OF CONTENTS
BILLING REQUEST
ACCEPTED RESPONSE
REJECTED RESPONSE |
