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Medical eBilling

Health Insurance - Legislative Overview

Health Division

Legislative Overview

HIPAA

State Farm Mutual Automobile Insurance Company's Health Division is a Covered Entity under the HIPAA law, therefore must comply with the Administrative Simplification provision.

The Administrative Simplification provision of HIPAA standardized the exchange of certain electronic data and established standards for the privacy and security of certain individual's protected health information.

Minnesota 62J.536

Minnesota Statutes, 62J.536, requires group purchasers and Health Care providers to use electronic claims and eligibility transactions. All Minnesota Health Care providers and group purchasers must use ASC X12 Version 5010 of the Minnesota Uniform Companion Guides.

Affordable Care Act

The Administrative Simplification section of the Affordable Care Act requires HIPAA covered entities to comply with new standards and operating rules for electronic transmissions. For detailed information regarding the individual operating rules, click here for Eligibility & Claim Status, or here for ERA/EFT.

ACA - Eligibility & Claim Status Operating Rules

CORE Rule Version for Connectivity

2.2.0

Details on the message format and the supported transactions

State Farm Health Division supports the CORE II 270 Connectivity rule for Eligibility and Claim Status in Real Time only, version 2.2.0.

Details about the entity's ASC X12 Interchange

Example - Will an interchange contain multiple functional groups; will the TA1 be in its own interchange without any functional group(s).

Example in PDF

Value of ReceiverID for that site

370533100

Production and Testing URLs for Real time (only)

PROD
SOAP: https://services.statefarm.com/b2b/core/soap
MIME: https://services.statefarm.com:3443/b2b/core/mime

TEST
SOAP: https://services.tcidv.statefarm.com/b2b/core/soap
MIME: https://services.tcidv.statefarm.com:3443/b2b/core/mime

Maximum size of Batch files that can be received by the Server

The maximum number of Real time transactions that can be sent per minute by a single Trading Partner is 10.

Authentication/Authorization policies using either X.509 Client Certificates or User ID and Password

Example - How to enroll and obtain a Client Certificate or UserID and Password to connect to that Receiver.

Email to HLTH-MEDICAL PROVIDERS Entity Name, primary contact, phone number, TIN, NPI (if applicable), email address. Once registered, User ID and Password will be communicated via email.

System Availability as required by Phase I CORE 157 System Availability Rule version 1.1.0 and Phase II CORE 250 Claim Status Rule version 2.1.0, 4.6: Claim Status System Availability

This system is virtually available 24/7 365 days. However, there are daily and weekly maintenance windows for the system components that could result in temporary unavailability. Any Scheduled Maintenance, Non-Routine, or Unscheduled system downtown will be reported as required in CORE II 270 Rule.

Business/Technical points of contact

ACA - EFT & ERA Operating Rules


CORE Rule Version for Connectivity

Phase II CORE 270 Connectivity Rule Version 2.2.0.

Enrollment of the CORE 270 Connectivity (Safe Harbor) will require Enrollee to agree to Safe Harbor Terms of Use, during ERA Enrollment.



ERA File Retrieval

ERA (835) files are available for retrieval via the Safe Harbor Method of Retrieval for 90 days from the date they are created. Each file retrieval request will result in a single file response if a file is available for the sender of the request for the date requested. If no file is available for the date requested, the response will contain an Error Code of “No File Found” and an Error Message of “No File for date requested available”.

Files are named with the following naming convention. The first component of the file name is your receiver ID, the second component is the date of the file you are requesting, and the third component is STATE FARM’s identifier followed by the type of file it is.

DEG 7, Preference for Aggregation of Remittance Data is where obtain your preference for your receiver ID.

1112223334_20130510_SFCORE.835

The following request would retrieve the above file.

<soapenv:Body>
<ns1:COREEnvelopeBatchResultsRetrievalRequest
xmlns:ns1="http://www.caqh.org/SOAP/WSDL/CORERule2.2.0.xsd">
<PayloadType>X12_005010_Request_Batch_Results_835</PayloadType>
<ProcessingMode>Batch</ProcessingMode>
<PayloadID>f81d4fae-7dec-11d0-a765-00a0c91e6bf6</PayloadID>
<TimeStamp>2013-05-10T10:20:34Z</TimeStamp>
<SenderID>1112223334</SenderID>
<ReceiverID>SFCORE</ReceiverID>
<CORERuleVersion>2.2.0</CORERuleVersion>
</ns1:COREEnvelopeBatchResultsRetrievalRequest>
</soapenv:Body>

Note: Normal processing will result in one file per Business day when remits were processed. However, we are aware that an anomaly to our processing could result in a second file being created for a given Business day. If this occurs you will be contacted and instructions will be provided on how to retrieve this exception file.

Error Handling

If the username and/or password included in the request are not valid an HTTP 403 error response will be returned.

Envelope Processing Status and Error Codes are handled per section 4.3.3.2 of CORE Phase II 270 rule.

Dual Delivery of v5010 X12 835 and Proprietary Paper Claim Remittance Advices

Once enrolled in ERA, you will receive dual delivery of the paper remittance, during the first 31 days and three payments, along with the ERA. Paper remittance will discontinue one the timeframes are met.

Providers currently enrolled in ERA, who sign up for electronic enrollment, will receive Dual Delivery.

Enrollee will have the option to opt out of Dual Delivery. Located on the ERA and EFT Enrollment page, a link to cancel Dual Delivery will be available.



Uniform Use of Codes

State Farm – Health has aligned our internal codes to correspond to the scenarios and code list specified by CORE.



Enrollee (Healthcare provider) will need to contact its financial institution to arrange for the delivery of the CORE-required Minimum CCD+ Data Elements necessary for successful reassociation of the EFT payment with the ERA remittance advice.



CORE-required Minimum CCD+ Reassociation Data Elements Corresponding v5010 X12 835 Data Elements
CCD+ Record # Field # Field Name Data Element Segment Position, Number & Name
5 9 Effective Entry Date BPR16 – 373 Date (EFT Effective Date)
6 6 Amount BPR02-782 Monetary Amount (Total Actual Provider Payment Amount)
7 3 Payment Related Information TRN Reassociation Trace Number Segment, specifically data elements (all required):
  • TRN01-481 Trace Type Code
  • TRN02-127 Reference Identification (EFT Trace Number) (State Farm Health Payment Number)
  • TRN03-509 Originating Company Identifier (Payer Identifier)
  • TRN04-127 Reference Identification (Originating Company Supplemental Code)
Resolving Late/Missing EFT and ERA Transactions

When an ERA or EFT is late/missing (four business days following the receipt of either the ERA or EFT) email HOME HLTH-MEDICALPROVIDER with your TIN, NPI, Method of Retrieval.

  • Missing ERA - please include the payment number (#########GH####)
  • Missing EFT - please include the TRN02 (EFT Trace Number) and, if available, the 2100 Other Claim Related Identification (this is our Bill ID)


ERA enrollment “only” is allowed.

EFT enrollment “only” is NOT allowed.

ERA enrollment is required prior to EFT enrollment.

When choosing your Method of Retrieval from State Farm – Health, (Emdeon, PNC Bank, UHIN, CORE Connectivity Safe Harbor), it is your responsibility to confirm your ability to receive your ERA through one of these connections.

EFT and ERA electronic enrollment applications are located on a secured B2B site. Assess to the secure B2B site starts with completion of the Contact Us form.

EFT & ERA Enrollment Instructions


State Farm Medicare Supplement Policies

Disclaimer

Verification of coverage is not a guarantee that payment will be made. It is only a statement of the in-force status of the policy and a description of the maximum benefits that it may provide. Payments of benefits is subject to the policy's coverage, exclusions and limitations.

For additional information contact us: 866-855-1212

State Farm accepts electronic bills from the Medicare coordination of Benefits Contractor (COBC). These transactions are received through an eligibility-based crossover process.

Medicare Coverage Plans

  Plan A Plan B Plan C Plan D Plan F Plan G Plan N
Medicare
Part A
Deductible
No
Coverage
Coverage Coverage Coverage Coverage Coverage Coverage
Medicare
Part B
Deductible
No
Coverage
No
Coverage
Coverage No
Coverage
Coverage No
Coverage
No
Coverage
Medicare
Part A
Coinsurance Coverage
Coverage Coverage Coverage Coverage Coverage Coverage Coverage
Medicare
Part B
Coinsurance Coverage
Coverage Coverage Coverage Coverage Coverage Coverage Coverage after:
$20-Office
Visit Co-pay;
$50-ER Visit
Co-pay, if
not admitted
Skilled Nursing
Facility Coinsurance
Days 21-100
No
Coverage
No
Coverage
Coverage Coverage Coverage Coverage Coverage
Medicare
Part B
Excess Charges
(100%)
No
Coverage
No
Coverage
No
Coverage
No
Coverage
Coverage Coverage No
Coverage
System Availability

Scheduled Downtime (regulary scheduled system downtime)

Monday - Friday 10 p.m. to midnight CST
Thursday 2 a.m. to 3 a.m.

Non-Routine Downtime

Unscheduled Downtime

Unscheduled Downtime will be posted as an "Alert" on the main Health Care Providers page of this site.

Holiday Schedule (2020)

The Holiday Schedule does not impact the CORE "Safe Harbor" process however these dates do have a reduced number of staff resources.

Holidays Date
New Years Day Wednesday, January 1, 2020
Memorial Day Monday, May 25 2020
Independence Day Saturday, July 4, 2020
Independence Day (observed) Friday, July 3, 2020
Labor Day Monday, September 7, 2020
Thanksgiving Day Thursday, November 26, 2020
Day After Thanksgiving Friday, November 27, 2020
Christmas Day Friday, December 25, 2020