Health Insurance - Legislative Overview
- Legislative Overview
- ACA - Eligibility & Claim Status Operating Rules
- ACA - EFT & ERA Operating Rules
- Medicare Supplement Policies
- System Availability
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 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
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).
Value of ReceiverID for that site
Production and Testing URLs for Real time (only)
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
CAQH CORE 350 – Health Care Claim Payment/Advice (835) Infrastructure Rule
CORE Rule Version for Connectivity
Phase II CORE 270 Connectivity Rule Version 2.2.0.
ERA File Retrieval Instructions
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.
The following request would retrieve the above file.
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.
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 184.108.40.206 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.
CAQH CORE 360 – Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule
Uniform Use of Codes
State Farm – Health has aligned our internal codes to correspond to the scenarios and code list specified by CORE.
CAQH CORE 370 – EFT & ERA Reassociation (CCD+/835) Rule
Receipt of the CORE-required Minimum CCD+ Data Required for Reassociation
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+ Data and corresponding v5010 X12 835 Data Elements
|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):
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)
CAQH CORE 380 – EFT Enrollment Data Rule & CAQH CORE 382 – ERA Enrollment Data Rules
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.
State Farm Medicare Supplement Policies
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|
Scheduled Downtime (regulary scheduled system downtime)
Monday - Friday 10 p.m. to midnight CST
Thursday 2 a.m. to 3 a.m.
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.
New Years Day
Independence Day (observed during weekday)
Day After Thanksgiving