decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2001 / AB-01-169
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Article Overview
This program memorandum explains CMS requirements for transaction certification and testing under HIPAA for Medicare carriers, fiscal intermediaries, and DMERCs. It outlines the general testing framework, transaction categories covered, training logistics, timelines, and related administrative expectations for contractor readiness. The article is relevant to billing operations, compliance teams, and Medicare systems staff involved in transaction testing and implementation.
Why This Topic Matters
It helps Medicare contractors understand the administrative and technical process CMS used to validate HIPAA transaction capability and prepare for trading partner testing. The memorandum also provides timing, training, and procedural context for organizations managing EDI readiness and compliance support.
Article Sections
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Program Memorandum and Subject
Introduces the memorandum, issuing organizations, transmittal information, date, and the overall topic of transaction certification and testing.
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General Requirements
Summarizes the overall testing approach, contractor scope, certification expectations, and the structure of the testing framework used for HIPAA transactions.
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Transaction Testing
Describes the testing process for inbound and outbound transactions, the use of base test files, and the types of transaction scenarios included in the testing program.
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Health Care Claim
Covers testing for claim-related transaction processing and the reporting process used to review results.
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Health Care Remittance Advice
Covers testing related to remittance advice transaction processing and analysis of outbound transaction results.
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Coordination of Benefits
Addresses testing related to coordination of benefits transaction scenarios and associated analysis procedures.
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Claims Status Inquiry/Response
Describes testing for claim status inquiry and response transactions and the related reporting workflow.
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Eligibility Inquiry/Response
Describes testing for eligibility inquiry and response transactions and the related reporting workflow.
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Training
Provides information on training logistics, regional office sessions, participation limits, and account setup for contractor staff.
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Timeframes
Outlines key milestones for contractor certification preparation, delivery of base test files, and availability of test suites.
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Costs
References cost-related information and notes the memorandum’s effective and implementation dates, along with retention guidance.
What You Will Learn
- How CMS structured HIPAA transaction certification and testing for Medicare contractors
- Which broad transaction categories were included in the testing program
- How training and testing timelines were organized for contractors
- What administrative steps were expected before and during certification testing
Who Should Read This
- Medicare contractors
- Billing and compliance staff
- EDI/transaction testing teams
- Healthcare IT and implementation staff
- CMS regional and contractor operations personnel
Codes Discussed
Code Ranges Discussed
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