epaces Overview HIPAA Strategy for New York Medicaid Health Insurance Portability and Accountability Act - 02/09/2006 Go ahead, we re listening.

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1 Health Insurance Portability and Accountability Act - HIPAA Strategy for New York Medicaid epaces Overview Go ahead, we re listening. 02/09/2006 C S C. C O M C O N S U L T I N G S Y S T E M S I N T E G R A T I O N O U T S O U R C I N G

ahead, we re listening. 02/09/2006 C S C.

2 February 9, What is epaces epaces is the electronic Provider Assisted Claim Entry System developed by Computer Sciences Corporation (CSC), on behalf of the New York State (NYS) Department of Health (DOH). epaces is a web-based Medicaid Solution especially developed for you the small providers to: enter and send HIPAA-compliant Claims (Institutional, Dental, Professional) Eligibility requests Claim Status Inquiry Service Authorization Dispensing Validation System transactions receive back HIPAA-Compliant Eligibility responses Claim Status Inquiry responses Service Authorization responses Dispensing Validation System responses.

epaces is a web-based Medicaid Solution especially developed for you the small providers to: enter and send HIPAA-compliant Claims (Institutional, Dental,

3 February 9, What is epaces epaces is designed with the smaller providers and clinics in mind who may not have sufficient resources or expertise to undertake the required changes in their billing and business processes to achieve HIPAA compliance. The Intension is to make epaces available free of charge. epaces is easy to use and we are promoting it as an incentive for our paper submitters to switch to an electronic format. All provider data will be housed in a central database in the data center, and not on their local PC. You will not have to spend time managing local databases.

The Intension is to make epaces available free of charge.

4 February 9, What is epaces Providers will log onto epaces over the Internet, and interact with web pages to enter and submit their transactions for processing. Providers will not have to be concerned with Electronic Data Interchange since epaces takes the HIPAA compliant data content you entered into epaces and creates the HIPAA EDI transactions automatically for you.

Providers will not have to be concerned with Electronic Data Interchange since epaces takes

5 February 9, What is epaces Because epaces is a web-based application, it is not necessary to install application software for provider installation. The most current version of the epaces application will be delivered to the client PC each time providers access it over the Internet. The epaces on-line help documentation can be found on the emedny website for you to review. The documentation is easy reading, and describes the epaces process in detail.

The most current version of the epaces application will be delivered to the client PC each time providers access it

6 February 9, What does the Provider need for epaces Providers will need to have the following in order to use epaces: A Personal Computer A browser (Netscape 4.7 or Microsoft Internet Explorer 4.01 and higher) Internet access address epaces runs in the browser environment instead of the operating system environment, providers are not constrained in their choice of operating system; they can run Microsoft, Macintosh, or Linux. Providers will not need to install any custom software

01 and higher) Internet access E-mail address epaces runs in the browser environment instead of the operating system

7 February 9, What does the provider need to do A provider must enroll to use epaces. The enrollment process can be found on the emedny website. Visit epaces Enrollment will take place over the Internet, and using . The enrollment process creates the System Administration account for a provider. Using the System Administration account you can create the user accounts you need in your organization to access epaces. The System Administrator will assign what functionality the user account has access to. epaces is a role based application. The individual user account menu bar will only contain the functions assigned by the System Administrator.

Using the System Administration account you can create the user accounts you need in your organization to access epaces.

8 February 9, epaces Security All information on the epaces application is sensitive and private in nature. The information transmitted over a Secured Socket Layer with 128-bit encryption. Privacy and security concerns will be mitigated because CSC will manage the the provider-specific data within a secure data center rather then locally in the providers office. The epaces users will enter their userid and password using a epaces login screen. An independent security process will authenticate the userid and password to ensure that only intended parties have access to the epaces application. Only users created by the System Administrator at the Providers site will be allowed in. Unknown users will not be allowed to go anywhere beyond the login screen. User passwords will be restricted to the functionality given to them by the System Administrator. The menu bar from which the user picks will only contain the options assigned to that user.

The epaces users will enter their userid and password using a epaces login screen.

9 February 9, What epaces is not The epaces application is not designed to replace or augment the claims payment editing logic or other adjudication processes within the emedny systems. epaces provides basic editing such as date validation and simple business rules. It does not in any way attempt to adjudicate a claim or other information. The adjudication of claim(s) and/or other information is the function of the emedny system. An epaces user should never assume that information accepted by the epaces application necessitates approval or payment by the NYS Fiscal Agent. Please refer to your billing manual or related instructions for details associated with the emedny.

It does not in any way attempt to adjudicate a claim or other information. The adjudication of claim(s) and/or other information is the function of the emedny system.

10 February 9, epaces HIPAA Functionality recap Functionality included in epaces 270 / 271 Eligibility for a Health Plan Inquiry and Response 278 Service Authorization inquiry and Response 278 Dispensing Validation System inquiry and response 278 Prior Approval request and response 837 Institutional Claim 837 Professional Claim 837 Dental Claim 276 / 277 Health Care Claim Status Inquiry and Response Administration Support Files Reporting using the Internet Browser Online Help

response 278 Prior Approval request and response 837 Institutional Claim 837 Professional Claim 837 Dental Claim 276 /

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