HIPAA Transaction Readiness
Since HIPAA’s inception, Molina Healthcare has worked diligently and collaboratively with the broader healthcare community to achieve compliance with the federal HIPAA transactions requirements. Molina Healthcare would like you to understand our HIPAA Transactions readiness.
HIPAA 5010 Transactions Readiness
Molina Healthcare is ready to conduct the following 5010A1 transactions with providers and other covered entities.
| Transaction Description | HIPAA Transaction Standard |
|---|---|
| Claims or Encounter Information | ASC X12N 837 Professional/Institutional/Dental Health Care Claims or Encounter (005010X222A1/005010X223A2/005010X224A2) |
| Eligibility for a Health Plan | ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response (005010X279A1) |
| Referral Certification and Authorization | ASC X12N 278 Health Care Services Review – Request for Review and Response (005010X217E2) |
| Claims Status | ASC X12N 276/277 Health Care Claim Status Request and Response (005010X212E2) |
| Payment and Electronic Remittance Advice | ASC X12N 835 Health Care Claim Payment/Advice (005010X221A1) |
| Health Plan Premium Payment | ASC X12N 820 Health Plan Premium Payment (005010X218E1) |
| Health Plan Enrollment/Disenrollment | ASC X12N 834 Health Plan Enrollment Maintenance (005010X220A1) |
| NCPDP Telecommunication Standard for Retail Pharmacy | Telecommunication Standard Implementation Guide Version D.0 Batch Standard Implementation Guide Version 1.2 (from Version 1.1) Medicaid Subrogation Standard Implementation Guide 3.0 (New Standard) |
HIPAA TCS Questions
For HIPAA TCS questions or concerns, please call our toll-free HIPAA Provider Hotline at 1-866-MOLINA2 (1-866-665-4622).
IMPORTANT NOTE: HIPAA does not require health care providers to conduct claims or other transactions electronically with Molina Healthcare. For example, if you currently submit claims to Molina Healthcare using paper, you may continue to do so.