Department of Civil Service

PA01-13

TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2001 NYSHIP Empire Plan Participating Agency Benefit Statements Name Change Transactions
DATE: July 9, 2001

NAME CHANGES ON EMPIRE PLAN BENEFITS STATEMENTS

The Empire Plan Benefits Statements that were sent out to Participating Agency enrollees in the New York State Health Insurance Program have resulted in a tremendous number of name change transactions. The Blue Cross enrollment system that preceded the New York Benefits Eligibility and Accounting System (NYBEAS) had the capability of carrying only first and middle initials for the enrollee and the initials were carried over into NYBEAS at conversion. NYBEAS has the capability for the full first name and we must, in fact, carry the full first name by October 2002 in order to comply with HIPAA regulations.

WHAT IS HIPAA?

In 2000, the Department of Health and Human Services issued final regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protecting the privacy of individually identifiable health records and standardizing transactions. The regulations are intended to ensure the security of medical records and other personal health information maintained by health care providers, hospitals, health plans, health insurers, and health care clearinghouses. Part of the standardizing of transactions is the requirement of transactions to include data such as full first name.

NAME CHANGES DO NOT NEED IMMEDIATE PROCESSING

Although we do need the name changes from first initial to full first name processed, there is no hurry at this time. Empire Plan Benefits Statements that are returned requiring other changes should be processed first. HBA Memo PA01-10 suggests an order of priority. HBA’s may process those that need only a name change from first initial to full first name over the next few months as time permits.

INSTRUCTIONS FOR NON-NYBEAS AGENCIES

Those agencies that do not have access to NYBEAS were instructed in HBA Memo PA01-10 to complete a PS-503.1 for each transaction resulting from a benefits statement and to send the PS-503.1 to the Employee Benefits Division along with a completed PS-516. A PS-503.1 does not need to be completed for a name change only. The completed benefits statement may be copied and the copy sent directly to the Employee Benefits Division. We do ask that the PS-516 be completed and sent with the statement(s) so that we may identify the sender should there be any questions. Completed transactions and benefit statements can be sent to: NYS Department of Civil Service, Employee Benefits Division, The State Campus, Albany, NY 12239.

SUSPENSION OF AUTOMATIC PRODUCTION OF I.D. CARDS

Due to the heavy volume of enrollee name changes being requested on the Participating Agency Empire Plan Benefit Statements, we have suspended the automatic production of a new NYSHIP Empire Plan Benefit Card for an enrollee name change. The Benefit Card the enrollee already has will continue to be valid. If you have processed a transaction that significantly changes the name (i.e. a last name change for a newly married enrollee) or if your enrollee requests a new card with their full name, please process an Empire Plan card request through the NYBEAS system or on a PS-503.1. You will be notified when this suspension of automatic card production is lifted.

QUESTIONS

Questions regarding transaction processing should be referred to the PA Unit processors at EBD:

Gail Schultz (518) 485-6619
Theresa Bartlett (518) 457-5847
Darci Jo Riddle (518) 457-5766
Jessica Dougrey (518) 485-6618