May 19, 2003
Dear Client,
The purpose of this letter is to help you complete the Computer Sciences Corporation, Trading Partner EDI Information Form, needed for HIPAA, dated April 30, 2003.
Page 1, Section 1:
Complete all questions. ETIN is your Electronic Transmitter Identification Number formerly known as the TSN (Tape Supplier Number). This number can be found by typing NHMA from any CHARTS screen and pressing ENTER. The field labeled Tape Supplier # (on line 2) contains your 3 character ETIN (TSN) number.
Page 1, Section 2:
Complete all questions.
Page 1, Section 3:
Complete all questions. The Technical / EDI Contact, Name, should be an employee of your facility not Reliable Health Systems, Inc. The Technical/EDI Contact Name may be the same individual you listed in Business Contact, Name.
Page 2, Section 4.1:
In the Check if sent column, place a (
T) alongside transaction type 837I and complete that line only as follows:Check if sent Transaction Version ISA05 ISA06 GS02 T 837I 004010X96A1 ZZ Tape Supplier Number Tape Supplier Number Page 3: In the NYS MMIS Electronic Gateway column place a (
Transaction NYS MMIS Electronic Gateway Physical Media Reel Tape Physical Media Cartridge
Tape Physical Media Diskette Other 837I T Page 4: Alongside Transaction type 837I complete both boxes as follows:
Transaction Receive NYS Medicaid
Generated 997? Receive NYS Medicaid
Generated Proprietary HIPAA Compliance Error? 837I Yes Yes If you are NOT currently receiving electronic cash receipt remittance tapes
from Medicaid you are finished. If you currently receive electronic remittance tapes from Medicaid place a
check in the Check if received column alongside transaction typed 835 and
complete as follows:
Check if received Transaction Version Physical Media Reel Tape Sent 997s to NYS Medicaid Physical Media Cartridge Tape Receive Proprietary Supplemental Information? T 835 004010X092A1 YES YES Thank you. Sincerely yours, Client Services
Reliable Health Systems, Inc.,
2610 Nostrand Avenue, Brooklyn, NY 11210
(718) 338 - 2400, Fax (718) 338
- 2741, www.ReliableHealth.com