HIPAA
As used herein the term "Company"refers to HM Life Insurance Company, HM Life Insurance Company of New York and HM Benefits Administrators, as applicable.
HIPAA Trading Partners
EDI Sign-up and Trading Partner Information
EDI trading partner sign up – Before conducting electronic data interchange (EDI) for HIPAA electronic transaction with our Company, trading partners must complete a new authorization process. This process includes completing an EDI Transaction Application form and executing an EDI Trading Partner Agreement with our Company. To request authorization for the exchange of HIPAA EDI transactions, select the appropriate link below based on your relationship with our Company.
Trading Partner Agreements:
Provider Trading Partner Agreement
Clearinghouse Trading Partner Agreement
Completed agreements should be sent to:
HM Benefits Administrators
Attn: HIPAA EDI Coordinator
P.O. Box 535059
Pittsburgh, PA 15253-5059
Implementation Guides
The ASC X12N 4010 implementation guides are available free of charge from the Washington Publishing company’s Web site: http://www.wpc-edi.com/hipaa.
Download EDI Reference Guides
In addition, our Company has published a set of companion documents to the national implementation guides that specify business requirements and clarifications for submitting transactions to our Company. These documents also identify what parts of the transaction our Company uses, sends or doesn’t need as part of processing. To access our Company’s EDI reference guides, go to the EDI Services specifications page by selecting the appropriate link below based on your relationship with our Company:
Trading Partner EDI Reference Guides:
ASC X 12N 835 – Health Care Claim: Payment/Advice
ASC X 12N 837 – Health Care Claim: Dental
ASC X 12N 837 – Health Care Claim: Institutional
ASC X 12N 837 – Health Care Claim: Professional
ASC X 12N 270/271– Health Care Eligibility Inquiry and Response
ASC X 12N 276/277 – Health Care Claim Status Request & Response
In accordance with the Administrative Simplification Provisions of HIPAA, our Company expects to be compliant with and fully able to process all the above transactions standards and all required code sets as set forth in the HIPAA Electronic Data Interface (EDI) regulations within the applicable required timeframe.
Please also note that our Company will still accept claims and process claim status inquiries and eligibility requests via paper, telephone and fax transmission, as we do now.
In order to submit transactions in a HIPAA EDI format, we must have a signed, completed Trading Partner Agreement and Valicert User Form. Within four to six weeks of receipt of the signed trading partner agreement, you will receive confirmation by e-mail or letter with your login ID and password.
Should you have any questions or concerns, please do not hesitate to contact us via the toll-free number and/or e-mail address referenced in the "Contact Us" section.
How to submit a Pharmacy Transaction – General Statement
If you are interested in submitting a pharmacy transaction, please contact the Business Coordinator for more details. Refer to the "Contact Us" section.
