Gateway 837 Companion Documents

Gateway Health Plan is pleased to announce that effective August 22, 2003 providers may bill WebMD using the 837 Version 4010A for both institutional and professional claim submissions as required by the Health Insurance Portability & Accountability Act (HIPAA). In an effort to assist you and your electronic data interchange (EDI) vendor to know what data is required in various segments within the 837 transactions, the Gateway Health Plan^® 837 Institutional and 837 Professional Companion Documents were created.

The Companion Documents will help to clarify what codes or identifiers Gateway Health Plan^® requires to efficiently process your electronic claims. The Companion Documents were designed for clarification purposes and to outline specific requirements for the transaction. Additionally, the Companion Documents should be used in conjunction with the HIPAA Implementation Guides (IG) that are available on the Washington Publishing Company's website. Due to the evolving nature of HIPAA regulations, these documents are subject to change. Please bookmark this Gateway Health Plan^® page and periodically look for updates: (http://gatewayhealthplan.com/providers/pa/hipaaediletter.aspx)

Only valid CPT-4 or HCPCs Procedure Codes, ICD-9 Diagnosis Codes and valid modifiers will be accepted for either electronic or paper claims as of October 2003. Gateway Health Plan^® will follow the Pennsylvania Department of Public Welfare's (DPW's) timeframe for eliminating local codes. Please check Gateway Health Plan's website for updated information.

Please send only HIPAA 837 Institutional Companion Document or 837 Professional Companion Document questions to Gateway HIPPA Contact. Please contact your Provider Relations Representative with any other questions that you may have.