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HIPAA/EDI Resources

NHP believes strongly in safeguarding the personal and health information of our members and expects all NHP providers to fully comply with all applicable state and federal regulations regarding confidentiality of health information, including but not limited to the privacy and security regulations promulgated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

It is important that privacy regulations do not impact patient treatment or quality of care. To that end, NHP providers should be aware that, absent specific authorization from the member, HIPAA allows for the exchange of information between NHP and our provider for treatment, payment and health care operations. Examples include but are not limited to:

  • Payment—The exchange of information needed to ensure that appropriate payment is made for services provided to members, including fulfilling authorization requirements, rendering payment, and conducting retrospective audits.
  • Health care operations—The collection of information for quality assessment and improvement activities such as Healthcare Effectiveness Data and Information Set (HEDIS) audits, medical record reviews, the investigation of grievances, quality of care issues or suspected fraud and abuse. The exchange of information that enables the coordination medical care for an NHP member by our team of Care Mangers or the provision of information to our providers concerning their patients’ utilization of medical services.

ICD-10 Readiness FAQ: pdf NHP’s claims processing system and reports and extracts are HIPAA 5010 and ICD-10 compliant in Production for all transaction types. Learn the critical details here.

HIPAA Companion Guides: Currently available: 270-271, 276-277, 278, 834, 835, 837

NHP Remote Access Request Form pdf All NHP contacts or his or her delegate must submit this form. All fields on page one must be filled out for all requests and all fields on page two for Lan-to-Lan requests.

NHP Request for Trading Partner Number: Upon receipt of this, NHP will send a confirmation letter which will contain all identifications numbers necessary for you to send transactions to NHP.

Protecting the Privacy of Patients' Health Information – U.S. Department of Health and Human Services Health Information Privacy website.

MassHealth HIPAA page

Legal information:

Disclaimer
Online Privacy and Security
Email Security
Copyright/Use Limitations
Notice of Privacy Practices – English pdf | Notice of Privacy Practices – Spanish pdf
HIPAA

Disclaimer

Neighborhood Health Plan supplies all information posted on this website. While we try to maintain only current and accurate information, we disclaim any implied warranty or representation about its accuracy or completeness, or appropriateness for a particular purpose. As the recipient of this information, you assume full responsibility for using the information at this web site, and you understand and agree that Neighborhood Health Plan is neither responsible nor liable for any claim, loss, or damage resulting from its use.

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Online Privacy and Security

In the normal course of visiting the NHP.org web site, viewing pages, or downloading information, we will gather and store certain information about your visit automatically. We use this information to help us make the site more useful to visitors – to learn about the number of visitors to our site and the types of technology our visitors use. Unless it is specifically stated otherwise, no additional information will be collected about you. When you visit NHP.org, some information is automatically collected including:

  • Your computer's IP address (the computer's unique signature)
  • Your computer's operating system (e.g. Windows XP)
  • Your Browser software (e.g. Microsoft Internet Explorer, Firefox, Safari, Chrome)
  • Your Internet Service Provider (e.g. Verizon, Comcast, RCN)
  • The date and time of your visit
  • The length of your visit
  • What pages you visited

This information does not personally identify you, nor is it shared with anyone outside of NHP. It is never sold.

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Email Security

Email sent over the Internet is not secure and should not be used to communicate confidential and/or health information directly to NHP. Please be aware that NHP cannot guarantee the confidentiality or security of any information you send to us over the Internet when using email. NHP shall not be liable for any breach of confidentiality resulting from such use of email via the Internet. NHP will not use email to communicate confidential and/or health information unless the e-mail is secured in accordance with NHP's Corporate Email Policy.

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Copyright Use Limitations

Copyright ©2013 Neighborhood Health Plan, Inc. All rights reserved. The information posted on this web site is protected by copyright and other intellectual property rights. It may be displayed, reformatted and printed for personal, non-commercial use only.

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HIPAA

HIPAA, the Health Insurance Portability and Accountability Act, is a federal law which requires health plans to implement additional security and privacy protections of member health information.

Privacy

Neighborhood Health Plan has always been committed to protecting member privacy and is now compliant with HIPAA regulations, as well as other State and Federal Privacy regulations.

Security

NHP currently maintains a high level of security consistent with industry standards. NHP has strived to meet and, where possible, exceed the national HIPAA Security standards. Constant monitoring and improvements are made to NHP's security infrastructure.

Transactions

NHP has actively engaged in updating systems and collaborating with regional providers and payers to implement transaction standards required by HIPAA. NHP is in compliance with the HIPAA transaction standards.

Our Companion Guides ensure the safe and secure testing and setup of electronic claims submissions with NHP.

Intended Audience

Neighborhood Health Plan Companion guides are intended for the business and technical areas, within or on behalf of a provider organization, responsible for the testing and setup of electronic claims submissions to Neighborhood Health Plan.

In addition, this information should be communicated to, and coordinated with, the provider's billing office in order to ensure that the required billing information is provided to its billing agent/submitter.

Purpose of the Companion Guides

Companion Guides are meant to assist the user with the submission of valid ANSI X12 transactions and should not be used as billing guidelines.

Download the guides

The following guides are currently available for download:

270-271 Companion Guide pdf: The guide includes details regarding the technical requirements necessary to transmit EDI information with NHP, and general information on setting up the trading partner relationship.

276-277 Companion Guides: The primary purpose of the companion guide is to assist the user with the submission of a valid 276/277 healthcare services review transaction and receipt of a valid 276/277 healthcare services response transaction.

278 Companion Guide: The primary purpose of the companion guide is to assist the user with the submission of a valid 278 healthcare services review transaction and receipt of a valid 278 healthcare services response transaction.

834 Companion Guide: The primary purpose of the companion guide is to assist the user with the submission of a valid 834 enrollment transaction.

835 Companion Guide: Neighborhood Health Plan (NHP) is publishing this Implementation Guide Companion Document to accompany the ASC X12N implementation guide for the ASC X12 Health Care Claim Payment/Advice (835) Transaction. This Document should be used in conjunction with the Implementation Guide and nationally standard code sets referenced in that Guide.

837 Companion Guide: The primary purpose of the companion guide is to assist the user with the submission of valid 837 transactions. These guides are specific to the 837 transaction sets with Neighborhood Health Plan. They are meant to supplement but not contradict any requirements in the 837 version 5010 Implementation Guide.