Electronic Transactions
Electronic transactions submitted to NIA must be HIPAA compliant so that member confidentiality is maintained. This Web page provides numerous tools and resources to assist you in preparing to send and receive electronic communications to/from NIA.
Companion Guides
The NIA Companion Guides provide detailed instructions on exchanging HIPAA compliant ASC X12N transactions with NIA. This document is designed for the technical departments or areas responsible for submitting electronic transactions to NIA. However, the business rules within these guides are to be communicated to and coordinated with the appropriate departments responsible for the capture or generation of any data required in the HIPAA standard transactions.
NIA Standard Companion Guide includes information regarding
- working with NIA
- connectivity
- contact information
- control segments
- NIA business rules
- acknowledgments
- testing
The transaction-specific Companion Guides include NIA's business rules specific to the individual type of transaction. Direct trading partners with NIA are to use all sections of both guides. Direct trading partners include NIA preferred clearinghouses for the provider-based electronic transactions (837P, 837I, 278, 276/277, 270/271, and 835) and providers that submit 837I or 837P electronic claims and receive electronic responses using the NIA Submit EDI Claims application on this Web site.
Indirect trading partners are providers that are able to generate and/or receive HIPAA compliant electronic transactions but who choose to work through a NIA-designated clearinghouse.
Each trading partner (direct or indirect) may use different transaction sets depending on their relationship to NIA. Transaction specific requirements are included in the transaction-specific companion guide. The information contained in these transaction-specific companion guides does not contradict any requirements in the corresponding HIPAA Implementation Guide. The HIPAA implementation guides provide standardized data requirements and content for all users. The implementation guides are intended to be compliant with the HIPAA data standards.
Transaction Companion Guides
- Standard Companion Guide (PDF 1M
) - 270-271 Eligibility Benefit Inquiry/Response
(PDF 429K )
- 276-277 Claims Status Request/Response (PDF 349K
)
- 277U Unsolicited Claims Status Response (PDF
326K )
- 278 Authorizations (PDF 133K )
- 835 Claims Remittance (PDF 884K , 2-3 minutes)
- 837I Institutional Claims (PDF 881K , 2-3 minutes)
- 837I Abbreviated Companion Guide (PDF 50K )
- 837P Professional Claims (PDF 942K , 2-3 minutes)
- 837P Abbreviated Companion Guide (PDF 46K )