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HIPAA: Health Insurance Portability and Accountability Act

EDI Information for Providers

The Health Insurance and Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191, included “Administrative Simplification” provisions that require the Department of Health and Human Services (HHS) to adopt national standards for electronic health care transaction.

These new regulations that govern electronic health care transactions go into effect October 16, 2003. Under the provisions of HIPAA all providers must bill MEDICARE HIPAA compliant electronic claims on and after the October 16, 2003 deadline. HIPAA does NOT require you to use electronic transactions with your other Health Plans or vendors; however, if you do use electronic transactions, they must meet the Standard and be compliant with HIPAA transactions and code sets.

If you provide services to the following programs administered by the Tennessee Department of Health (TDH), you may continue to bill the Department by submitting paper claims:

  • Alcohol and Drug Program
  • Renal Disease Program
  • Breast and Cervical Program
  • Children’s Special Services
  • Hemophilia
  • Ryan White

However, if you feel that your volume of claims for these programs are high enough to be cost effective to submit electronically, TDH will be able to accept your electronic claims on October 16, 2003 if you meet the following requirements:

Companion Guides

TDOH Companion Guides are available by clicking on the following links:

Pharmacy Claims

TDH accepts National Council for Prescription Drug Program Batch Standard Version 1.1.  See the NCPDP's website for additional information. www.ncpdp.org.

Clearing Houses that have successfully completed EDI testing for specific transactions with TDH are listed below. TDH does not endorse or recommend any of these companies.

      •  To date, no clearing house has successfully completed EDI testing with TDH.

If you have additional questions regarding filing claims electronically with the Tennessee Department of Health, you can contact us by email at edi.health@tn.gov or by phone at 1-877-280-0054

EDI Testing Process

A request to begin testing must be submitted to the following email address: edi.health@tn.gov

The following items are to be included in your request:

  1. Company Name
  2. Company Telephone Number with extension if applicable
  3. Company Fax Number
  4. Contact First Name
  5. Contact Last Name
  6. Contact Email Address
  7. Company Address, City, State & Zip Code
  8. Transactions Types to be tested
  9. Company Category: (e.g.:  Clearing House, Software Vendor, Healthcare Provider,  HMO, Hospital, MCO, Medicare)

Once the request is received, the trading partner will receive notification and will be sent to the requestor containing a URL, User Login ID, User Password and login instructions.

 All questions about EDI Testing should be sent to the following email address: edi.health@tn.gov