HIPAA/EDI

EGA is committed to complying with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The information below reflects our current compliance status in relation to the standard EDI transaction sets. Please feel free to contact our office if additional information is required. The following link is provided to facilitate HIPAA Compliance discussions: e-mail to: hipaa@ega-inc.com. Employers are subject to the HIPAA Privacy Rule.

Application Software
Because EGA maintains a staff of in-house programmers, we are able to enhance our application software as needed. The vendor of our application software, United Systems and Software, Inc., has developed an add-on package for translation of EDI transactions into or from the claims administration application.

Transaction Sets
ASC X12N 837 Health Care Claim: Professional
We currently accept these transactions through Emdeon Business Services. Our payer ID is 23250. Additional options are available for our PPO partners.

ASC X12N 837 Health Care Claim: Institutional
We currently accept these transactions through Emdeon Business Services. Our payer ID is 23250. Additional options are available for our PPO partners.

ASC X12N 837 Health Care Claim: Dental
We currently accept these transactions through Emdeon Business Services. Our payer ID is CX046.

ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response
We currently accept 270 Eligibility Benefit Inquiry transactions and provide 271 Eligibility Benefit Response transactions via Emdeon Realtime Transaction processing. Our payer name is "ERIN."

ASC X12N 278 - Health Care Services Review
Based on the implementation guide for this transaction set, only UMO's are required to receive this information.

ASC X12N 276/277 Health Care Claim Status Request and Response
We currently accept 276 Claim Status Request transactions and provide 277 Claim Status Response transactions via Emdeon Realtime Transaction processing. Our payer name is "ERIN." In addition, we are able to provide 277 Unsolicited Claim Status in response to Health Care Claim transactions received in batch mode.

ASC X12N 834 - Benefit Enrollment and Maintenance
We offer X.12 834 transactions for eligibility downloads to our PPO partners upon request. Our self-funded clients can currently enroll new employees and submit termination requests to us via our secured Employer web site

ASC X12N 835 - Health Care Claim Payment/Advice
We offer X.12 835 ERA transactions with ACH payment through Emdeon Business Services. Please enroll with Emdeon at www.emdeon.com/enrollment. Additional options are available through our PPO partners.

Code Sets
ICD-9-CM Volumes 1, 2 and 3
We currently use this code set as required.

Code on Dental Procedures and Nomenclature
We currently use this code set as required.

Health Care Financing Administration Common Procedure Coding System (HCPCS)
We currently use this code set as required.

Current Procedural Terminology (CPT-4)
We currently use this code set as required.

Links to Non-EGA Web Sites
Links are provided within our web site to non-EGA web sites. By supplying a link to these web sites, EGA does not endorse these web sites nor are we responsible for their privacy policies or content. Concerns should be directed to the owner of these web sites. We review these links periodically to ensure that they are valid.