Standards and Specifications
Overview || Utah State Rule for Clinical Information (R380-70) || Utah State Rule for Billing Transactions (R590-164)
| Title | Description |
Version/ Format |
Standard/ Specification |
|---|---|---|---|
| Eligibility Inquiry/ Response Standard (270/271) | This standard establishes a uniform method of eligibility inquiry and responses practices within the State of Utah. | 4010 | Standard |
| Eligibility Inquiry and Response Standard (270/271) | This standard establishes a uniform method of eligibility inquiry and responses practices within the State of Utah. | 5010 | Standard |
| Claim Status Inquiry and Response Standard (276/277) | This standard establishes the uniform method for the Claim Status transaction (276/277) in the State of Utah. This standard applies to both payers and providers and sets minimum requirements for each. | 4010 | Standard |
| Claim Status Inquiry and Response Standard (276/277) | This standard establishes the uniform method for the Claim Status transaction (276/277) in the State of Utah. This standard applies to both payers and providers and sets minimum requirements for each. | 5010 | Standard |
| Claim Acknowledgement Standard (277CA) | This Standard establishes the use of the ASC X12 277 unsolicited transaction to use as a claim acknowledgement for claim submission. This Standard also includes the UHIN Implementation Guide for the required transaction. | 5010 | Standard |
| Front End Acknowledgement Standard (277FE) | This standard establishes the use of the ASC X12 277 unsolicited transaction to use as a front-end acknowledgement for claim submission within the State of Utah. This standard also includes the UHIN Implementation Guide for the required transaction. | 4010 | Standard |
| Front End Acknowledgement Cross Walk Specification | This is a supporting document that provides a uniform method for the use of the STC codes within the 277FE. This document is meant to be used in conjunction with Front End Acknowledgment Standard. | 4010 | Specification |
| Prior Authorization/Referral Standard (278) | This standard establishes the uniform method for the Prior Authorization/Referral transaction (278) in the State of Utah. This standard applies to both payers and providers. | 4010 | Standard |
| Prior Authorization/Referral Standard (278) | This standard establishes the uniform method for the Prior Authorization/Referral transaction (278) in the State of Utah. This standard applies to both payers and providers. | 5010 | Standard |
| Billing Compendium Standard | This standard establishes the format and column header information for a Third-Party Payer Compendium by labs for externally ordered clinical labs. | HL7 | Standard |
| Laboratory Test Compendium Standard Summary |
This standard establishes the format and column header information for Directory of Services and Ask-Order-Entry Compendium supplied by laboratories for externally ordered clinical labs. | HL7 | Standard |
| Benefits Enrollment and Maintenance Standard (834) | This standard establishes the use of the ASC X12 834 Enrollment transaction for Utah State Medicaid enrollments. | 4010 | Standard |
| Benefits Enrollment and Maintenance Standard (834) | This standard establishes the use of the ASC X12 834 Enrollment transaction. | 5010 | Standard |
| Medicaid Enrollment Implementation Guide Standard (834) | This standard establishes the use of the ASC X12 834 Enrollment transaction for Utah State Medicaid enrollments. | 5010 | Standard |
| Electronic Remittance Advice Standard (v4010 - 835) | This Standard establishes the uniform standard for the electric remittance advice transaction used in the State of Utah. | 4010 | Standard |
| Electronic Remittance Advice Standard (835) | This Standard establishes the uniform standard for the electric remittance advice transaction used in the State of Utah. | 5010 | Standard |
| Coordination of Benefits Standard (837 - 4010) | This UHIN Standard is intended to streamline the coordination of benefits process between payers and providers. The overall goal of this standard is to define the minimum data to be exchanged for the coordination of benefits (COB). | 4010 | Standard |
| Coordination of Benefits Standard (837) | This UHIN Standard is intended to streamline the coordination of benefits process between payers and providers or payer to payer. The overall goal of this standard is to define the minimum data to be exchanged for the coordination of benefits (COB). | 5010 | Standard |
| Health Care Claim Encounter Standard (837) | This Standard details the use of the HIPAA 837 implementation guides for UHIN members. | 5010 | Standard |
| Health Care Claim Encounter Standard (v4010 - 837) | This Standard details the use of the HIPAA 837 implementation guides for UHIN members. | 4010 | Standard |
| Error Report Specification (864) | This Specification may be used by agreeing trading partners to communicate semantic and implementation guide level syntax errors at a minimum. This guide is not intended to replace or be used in lieu of the 277FE. Medicare will be using this specification to report semantic, implementation syntax, content errors and accepted Claim counts in conjunction with the 997. | 4010 | Specification |
| Functional Acknowledgement Transaction Standard (997) | This standard establishes the use of the ASC X12 997 transaction for use as a functional acknowledgement for HIPAA transactions in the State of Utah. | 4010 | Standard |
| Implementation Functional Acknowledgement for Healthcare Insurance Standard (999) | This standard applies to all X12 "batch"' transactions and will be adopted with the implementation of the 5010 837 transaction. The 999 can be sent by both payers and providers to acknowledge receipt of batch transactions. | 5010 | Standard |
| Administrative Transaction Acknowledgements Specification | This document details the appropriate acknowledgements for various transactions/messages. | 4010 | Specification |
| Administrative Transaction Acknowledgements Standard | This document details the appropriate acknowledgements for various transactions/messages. | 5010 | Standard |
| Admit Discharge Transfer Specification | This Specification details the technical requirements of the HL7 Admit Discharge Transfer messages (HL7 Version 2.3) | HL7 | Specification |
| Anesthesia Standard |
This standard provides rules for billing anesthesia claims in the State of Utah. |
4010 | Standard |
| Anesthesia Standard | This standard provides rules for billing anesthesia claims in the State of Utah (5010). | 5010 | Standard |
| Antepartum Record Specification | This Specification details the technical requirements of the HL7 Antepartum Record document | HL7 | Specification |
| Change Management Specification | This UHIN Specification is intended to provide a process for UHIN members to follow when changes to UHIN services are requested or implemented. | Other | Specification |
| Chief Complaint Standard | This Standard details the technical requirements for entities to report Chief Complaint Data to the Department of Health (HL7 Version 2.4). | HL7 | Standard |
| Clinical Acknowledgement and Error Status Standard | This Standard details the technical requirements for Acknowledgements and Error Status (HL7 Version 2.2 thru Version 2.5) | HL7 | Standard |
| Clinical Header and Trailer Specification | This Specification details the technical requirements for header and trailer segments for HL7 messages (HL7 Version 2.2 thru Version 2.5). | HL7 | Specification |
| Clinical Laboratory Orders Standard | This Standard details the technical requirements of Clinical Laboratory Result (HL7 Version 2.2) | HL7 | Standard |
| Clinical Laboratory Results Standard | This Standard details the technical requirements of Clinical Laboratory Result (HL7 Version 2.2) | HL7 | Standard |
| CMS 1500 Paper Claim Form Box 17 and 17A Standard | This standard establishes a standard approach to reporting referring provider name and identifier number on the CMS 1500 claim form. | 5010 | Standard |
| Continuity of Care Document Specification | This Specification adopts the HITSP C32 construct for the Continuity of Care Document (CCD) for the exchange of summary patient data in the state of Utah. | HL7 | Specification |
| Metabolic Dietary Products Standard-Coverage for | This standard establishes standard billing practices for metabolic dietary products in the State of Utah. | 4010 | Standard |
| Metaboloic Dietary Products Standard | This standard establishes standard billing practices for metabolic dietary products in the State of Utah. | 5010 | Standard |
| Dental Claim Billing Standard | This document details the new ADA J400 Paper Claim Form. | 5010 | Standard |
| Dental Item Number Elements Standard | This document details the new ADA J400 Paper Claim Form. | 4010 | Standard |
| Discharge Summary Standard | This Standard details the technical requirements of the HL7 Discharge Summary messages (HL7 Version 2.3) | HL7 | Standard |
| Electronic Funds Transfer (EFT) and Automated Clearing House (ACH) Specification | This document details the crosswalk between the ACH and provides guidance for UHIN members on the EFT and ACH transactions. | Other | Specification |
| EDI Enrollment Specification | This specification outlines the information and requirements for provider to enroll as an EDI trading partner with payers in order to exchange electronic transactions. | Other | Specification |
| Facilities Common Edits Standard | This standard establishes the common (UHIN) edits for facility (institutional) claims submitted in the State of Utah. | 4010 | Standard |
| HCFA 1500 Box 17 and 17A Standard | This standard establishes a standard approach to reporting referring provider name and identifier number on the HCFA 1500 claim form. | 4010 | Standard |
| Health Identification Card Standard | This standard standardizes the patient identification card information. This card addresses the human-readable appearance and machine readable information used by the healthcare industry to obtain eligibility and/or benefit information | Other | Standard |
| History and Physical Standard | This Standard details the technical requirements of the HL7 History and Physical messages. | HL7 | Standard |
| Home Health Standard | This standard establishes standard billing practices for Home Health and Home Infusion claims in the State of Utah. | 4010 | Standard |
| Home Health Standard | This standard establishes standard billing practices for Home Health and Home Infusion claims in the State of Utah (5010). | 5010 | Standard |
| Immunization Standard | This standard is an implementation guide for the messaging framework of Immunization messages for entities who send Immunizations messages to the Utah Department of Health | HL7 | Standard |
| Individual Name Standard | This standard establishes guidance for entering names into any Utah provider, payer or sponsor systems for patients, enrollees, as well as all other people associated with these records | Other | Standard |
| Master Patient Index and Provider Address Book Specification | This Specification is to detail the data contained in the Master Patient Index and the Provider Address Book Databases for the UHIN Clinical Health Exchange. This Specification further describes the methods of populating and maintenance. |
Other | Specification |
| Minimum and Recommended Hardware Requirements Specification | This specification establishes the minimum hardware requirements for connecting to the UHIN gateway and using UHIN base line translators to connect to UHINet. | Other | Specification |
| National Provider Identifier Standard (4010) | This UHIN Standard is intended to assist with the transition from legacy provider numbers to the NPI for payer and providers. | 4010 | Standard |
| National Provider Identifier Standard | This UHIN Standard is to inform providers of the NPI requirements and the usage within X12 transactions. | 5010 | Standard |
| Operative Report Standard | This Standard details the technical requirements of the HL7 Operative Report messages (HL7 Version 2.3) | HL7 | Standard |
| Property & Casualty Health Care Claim/Encounter Specification (837) | This Specification details the use of the HIPAA 837 implementation guides for Property and Casualty Claims and Encounters. | 5010 | Specification |
| Property & Casualty Professional (CMS1500) Claim Form Standard | This document clearly describes the use of each Professional (CMS1500) Form box and its crosswalk to the 5010 837 professional implementation guide specifically for Property and Casualty. | 5010 | Specification |
| Property & Casualty UB04 Claim Form Locator Elements Standard | This document clearly describes the use of each UB04 Paper Claim Form box and its crosswalk to the 5010 837 institutional implementation guide specifically for Property and Casualty. | 5010 | Specification |
| Property & Casualty Electronic Remittance Advice Specification | This Specification details the use of the HIPAA 835 implementation guide for Property and Casualty Electronic Remittance Advice. | 5010 | Specification |
| Pain Management Standard | This standard establishes a uniform method of submitting pain management claims/encounters, pre-authorizations and notifications. | 4010 | Standard |
| Pain Management Standard | This standard establishes a uniform method of submitting pain management claims/encounters, pre-authorizations and notifications (version 5010). | 5010 | Standard |
| Patient Identification Number Standard | This describes the patient identification number standard in the state of Utah. | 5010 | Standard |
| Patient Identification Number Standard (4010) | This standard establishes the SSN as the Utah standard for the patient's identification number. | 4010 | Standard |
| Payer, Provider and Vendor Network Requirements Specification | This standard defines the network connect requirements for payers, providers and vendors. | Other | Specification |
| Premium Payment Standard (5010) | This standard defines the electronic transmission of premium payments (820). | 5010 | Standard |
| Professional Claim (CMS 1500 ) Standard (4010) | This document details the new CMS 1500 Paper Claim Form. | 4010 | Standard |
| CMS 1500 Paper Claim Form Standard | This document clearly describes the Standard use of each CMS 1500 Paper Claim Form box and its crosswalk to the 5010 837 Professional implementation guide. | 5010 | Standard |
| Professional Common Edits Standard | This standard establishes the common (UHIN) edits for professional claims submitted in the State of Utah. | 4010 | Standard |
| Provider Data Exchange Specification | This specification details the manner in which provider data is exchanged between providers and enrollment/credentialling entities (e.g. payers). | Other | Specification |
| Psychiatric Day Treatment Standard | This standard establishes a uniform method of transacting psychiatric day treatment billing, prior authorization and referral practices. - RETIRED | 4010 | Standard |
| Radiology Report Standard | This Standard details the technical requirements of the HL7 Radiology Report (text) messages (HL7 Version 2.3) | HL7 | Standard |
| Required Unknown Values Standard (4010) | This UHIN Standard is intended to provide rules for the use of common data values that can be used within the HIPAA transactions when a required data element is not known by the provider, payer or sponsor for patients, enrollees, as well as all other people associated with these transactions. | 4010 | Standard |
| Required Unknown Values Standard | This UHIN Standard is intended to provide rules for the use of common data values that can be used within the HIPAA transactions when a required data element is not known by the provider, payer or sponsor for patients, enrollees, as well as all other people associated with these transactions. | 5010 | Standard |
| Router Client Connection Document (Legacy) |
This document explains how to connect (Legacy) to UHINet as a provider. |
Other | Other |
| Route Server Connection Document (Legacy) |
This document explains how to connect (Legacy) to UHINet as a Route Server. |
Other | Other |
| Security Specification | This specification establishes standard security practices for UHINet (gateway) and UHIN application users. | Other | Specification |
| Service Level Specification (UHIN cHIE) | This specification sets forth the service level definitions, measurements thereof, and related service standards that will be provided by UHIN to members that are participating with the cHIE. | Other | Specification |
| Sender and Receiver Identification In the ISA and GS Segments Specification | This specification establishes a standard use for various elements in the ISA and GS segments. | Other | Specification |
| Standards Goals |
These are the goals for the Standards Committee. |
Other | Other |
| Standards Meeting Minutes | Approved Meeting Minutes for past Standards Committee Meetings | Other | Other |
| Standardized Laboratory Test Result Identifiers Standard | This Standard is an usage guide for standardized laboratory test result identifiers. These identifiers are a subset of Logical Observation Identifiers Names and Codes (LOINC) used in laboratory result message exchanges | HL7 | Standard |
| Technical Reference Manual (TRM) |
This document explains the technical details about UHINet II and it associated systems. It also details how to connect to UHINet II via SOAP over HTTPS as a Route Server and/or as a Router Client. |
Other | Other |
| Telehealth Standard | This standard establishes standard billing practices for Telehealth claims in the State of Utah. | 5010 | Standard |
| Telehealth (v4010) Standard | This standard establishes standard billing practices for Telehealth claims in the State of Utah. | 4010 | Standard |
| Trading Partner Number Specification | This specification establishes a standard trading partner number and UHIN routing number practices for the UHIN network. | Other | Specification |
| Transaction Testing and Certification Specification | This specification establishes standard testing and certification practices for all HIPAA compliant transactions. | Other | Specification |
| Transparency Administration Standard | This standard establishes performance measures that report the average telephone answer time and claim turnaround time for payers. | Other | Standard |
| Transparency Denial Standard | This standard establishes performance measures that report the number and cost of an insurer's denied health care claims and provides guidance pertaining to the reporting method and timeline. | Other | Standard |
| UB04 Form Locator Elements Standard | This document details the new UB04 Paper Claim Form. | 4010 | Standard |
| UB04 Claim Form Locator Elements Standard | This document clearly describes the Standard use of each UB04 Paper Claim Form box and its crosswalk to the 5010 837 institutional implementation guide. | 5010 | Standard |
| Web Services (TRM) Developer Helpful Hints | This document contains pending TRM documentation updates and developer helps as organizations create Web Services connection to UHINet II. |
Other | Other |
| Web Services Implementation Status | This document contains a listing of organizations and contact information showing Web Services implementation status by method (e.g. download, batch upload) and applicable trading partner number. | Other | Other |
| Web Services Network Connection Specification | This document details the methodology and requirements for creating direct connection to UHINet II via SOAP over HTTPS for sending and receiving version 5010 transactions and messages. | 5010 | Specification |