The Department of Human Services, Med-QUEST
Division, is responsible for ensuring HIPAA compliance for Hawaii
Medicaid program. This includes health plans, and fee for service
providers. Med-QUEST works with the fiscal agent to review requirements,
write regulations, and revise operational procedures.
HIPAA compliance consists of three components: privacy, security,
and transactions and code sets (TCS).
Privacy
Med-QUEST is committed to the protection of an individual’s
health information and was compliant with all the requirements
of the Privacy Rule on April 14, 2003. Our efforts to date include:
-
Pre-emption analysis of HIPAA privacy rule and other relevant
federal Medicaid and state regulations.
-
Development of a strategy to analyze and implement the HIPAA
Privacy rule requirements.
- Review
of organizational practices to determine potential gaps with
HIPAA compliance.
-
Development and implementation of administrative, technical,
and physical safeguards to protect health information.
-
Participation with other covered entities to develop consistent
practices
-
Development of the following Med-QUEST policies and practices:
- Notice
of Privacy Practices, which will go out to all current
Medicaid recipient households before April 14 and to all
new applicants and recipients thereafter.
-
DHS Department level policies and Med-QUEST divisional policies
and procedures in conformance with the Privacy Rule
-
Identifying business associates and Business Associate contract
language, which will be inserted in all business associate
contracts starting July 1, 2003.
- New
Authorization forms have been developed for any requests
for information maintained by MQD.
For
your convenience, the above notice and forms are available in
the forms section of this
Web-Site.
Med-QUEST conducted DHS departmental training and Privacy policy
and procedure training for all affected staff in March 2003.
Security
The final Security Rule
was published in the Federal Register February 20, 2003. The compliance
date is April 21, 2005. Med-QUEST has performed initial security
assessments in conjunction with the Privacy rule.
Transactions and Code Sets
Med-QUEST successfully implemented the following
transactions for the October 2003 TCS Implementation:
-
837 Fee For Service Claims
-
835 Electronic Remittance Advice
-
270/271 Eligibility Verification Request and Response
-
276/277 Claim Status Request and Response
-
834 Health Plan Roster
-
820 Premium Payment
Med-QUEST
is able to accept and process all of the above transactions. Trading
partners interested in exchanging the above electronic transactions
with Med-QUEST are urged to contact ACS, the Med-QUEST fiscal
agent, at (808) 952-5570 (O’ahu and mainland) or (800) 235-4378
(Neighbor Islands).
Please note Med-QUEST does not exchange electronic
claims and remittance advice directly with QUEST providers. Instead,
QUEST providers work with the various QUEST health plans. QUEST
providers must contact health plans, not ACS, for issues related
to electronic claims and remittance advice. Health Plans may contact
Med-QUEST directly for transaction-related issues.
Med-QUEST successfully converted most of its
local codes on October 16, 2003. Social Services Division (SSD)
local codes will convert in January 2004. Med-QUEST will convert
the remaining local codes as instructed by Medicare. In October
2003 Med-QUEST and SSD notified all affected providers of local
codes changes.
Med-QUEST will continue to implement TCS transactions
as mandated by federal law.
