Instructions for How to Use the Quick Code Reference List

Transcription

1 Instructions for How to Use the Quick Code Reference List The Quick Code Reference List was compiled as a convenient resource to let EDI jurisdictions and their trading partners know what codes were valid for each Maintenance Type Code. As new codes are added to the standard, they are also included in the Quick Code Reference List. Jurisdictions are free to use the standard Quick Code Reference List, but it is important that they not delete lines in the document but merely gray out the lines they don t use. There are three reasons for this directive: 1. The Quick Code Reference List is in Excel and the formatting is very precise and easily disrupted by deleting or adding fields. 2. Using the full list will assure trading partners that the jurisdiction has considered the use of all the codes and is not overlooking some. 3. The jurisdiction may want to add some existing codes in the future and all it will need to do is to restore the original color of the cell by removing the gray shading. (c) IAIAC 2017

2 IAIAC Claims Release 3.1 Change Log WorkSheet Changed Change Description Change Reason/Purpose IAIAC Release Publication Change Number Revision Added DN0229 Injury Severity Type Code CLM793R /1/2016 QCR1 1/1/2016 Added new Claim Type Codes W and P to 3.0 1/1/2016 QCR2 1/1/2016 CLM785R3.0 DN0074 Claim Type Code Revised codes for DN0085 enefit Type Code 3.0 1/1/2016 QCR3 1/1/2016 (220, 221) Add Employer Paid TCs 220 CLM770R3.0 (Employer Paid Permanent Total enefits) and Revised codes for DN0092 enefit Adjustment 3.0 1/1/2016 QCR4 1/1/2016 Code (3). Added new enefit Adjustment Code IRR767R3.0 (DN0092) value of 3 (Post Injury Wage Earning Employer Paid TCs (2xx) and Acquired OTs SYS778R /1/2016 QCR5 1/1/2016 (430 and 440) were removed from Payment Reason Code (DN0222) The changes below are for Release 3.1 Add new Maintenance Type Code DN0002: SU Sync Up Earliest Implementation IRR /15/2017 QCR6 8/15/2017 8/15/2018 Add new Maintenance Type Code DN0002 for SROI: AC Acquisition/Indemnity Ceased IRR /15/2017 QCR7 8/15/2017 8/15/2018 Add new Maintenance Type Code DN0002 for IRR /15/2017 QCR8 8/15/2017 8/15/2018 SROI: MTC: NT NARRATIVE New DN: INITIAL RTW TYPE CODE DN0403 IRR /15/2017 QCR9 8/15/2017 8/15/2018 A = Actual R = Released New DN: LATEST RTW TYPE CODE IRR /15/2017 QCR10 8/15/2017 8/15/2018 DN0406 A = Actual R = Released New DN: CHANGE REASON CODE - DN0413 A = (Add) A data element was previously blank/null in the database and has been changed to a value. U = (Update) A data element was previously a value in the database and has been changed to another value. R = (Remove) A data element was previously a value in the database and has been changed to blank/null. D = (Delete) A variable segment occurrence has been removed in its entirety. Data elements within the segment are not required to be identified in the change variable segment as Remove. IRR /15/2017 QCR11 8/15/2017 8/15/2018 EDI-Claims-R3.1.0_Quick-Code-Reference (Pub _Rev ) 2 IAIAC Change Log

3 IAIAC Claims Release 3.1 Change Log WorkSheet Changed Change Description Change Reason/Purpose IAIAC Release Publication DEPENDENT/PAYEE RELATIONSHIP CODE DN0097 N = Numerical irth Order A =10 = 11 C = 12 D = 13 E = 14 F = 15 G = 16 H = 17 I = 18 J = 19 K = 20 Add new DN: CANCEL REASON CODE - DN0400 Values: D = Duplicate/Combined Claim J = Jurisdiction Wrong/Changed N = Not Required y Jurisdiction R= Disputed Request y Jurisdiction Add New DN DEPENDENT EXTENT OF DEPENDENCY DN0429 F = Full dependency P = Partial dependency Add New DN SUSPENSION REASON CODE FULL - DN0418 Values : refer to IRR for detailed list DP Rule: Suspension Reason Code Partial is required when MTC is Px Change Number Revision Earliest Implementation IRR /15/2017 QCR12 8/15/2017 8/15/2018 IRR /15/2017 QCR13 8/15/2017 8/15/2018 IRR /15/2017 QCR14 8/15/2017 8/15/2018 IRR /15/2017 QCR15 8/15/2017 8/15/2018 Add New DN SUSPENSION REASON CODE - PARTIAL - DN0419 Values: refer to IRR for detailed list DP Rule: Suspension Reason Code Partial is required when MTC is Px IRR /15/2017 QCR16 8/15/2017 8/15/2018 Maintenance Type Code (DN0002) for SROI: Remove Values: S1,S2,S3,S4,S5,S6,S7,S8,S9,SD,SJ Maintenance Type Code (DN0002) for SROI: Remove Values: P1,P2,P3,P4,P5,P7,P9,PJ New DN: PART OF ODY INJURED LOCATION CODE DN0421 -ilateral L-Left R-Right IRR /15/2017 QCR17 8/15/2017 8/15/2018 IRR /15/2017 QCR18 8/15/2017 8/15/2018 IRR /15/2017 QCR19 8/15/2017 8/15/2018 EDI-Claims-R3.1.0_Quick-Code-Reference (Pub _Rev ) 3 IAIAC Change Log

4 IAIAC Claims Release 3.1 Change Log WorkSheet Changed Change Description Change Reason/Purpose IAIAC Release Publication New DN: PART OF ODY INJURED FINGERS/TOES LOCATION CODE DN Index Finger or 1st Toe 2- Middle Finger or 2nd Toe 3 Ring Finger or 3rd Toe 4 Little Finger or 4th (little) Toe New DN: PERMANENT IMPAIRMENT ODY PART LOCATION CODE DN0432 -ilateral L-Left R-Right Add Maintenance Type Code (DN0002) for SROI: MTC PX and SX Remove Maintenance Type Code (DN0002) for SROI: MTC P1 through PJ and S1 through SJ Add/Revise Maintenance Type Code (DN0002) for FROI and SROI: UR Update Report vs UR Upon Request Remove RTW DNs- no longer used: RETURN TO WORK TYPE CODE DN0189 RETURN TO WORK WITH SAME EMPLOYER INDICATOR DN0228 PHYSICAL RESTRICTIONS INDICATOR DN0224 Payment Reason Code (DN0222): Sync up the codes based on what the Dictionary says: See enefit Type Code and Other enefit Type Code values for medical (350, 360, 370, 450, 455, 460, 465, 470), funeral (300), penalty (310, 311), and attorney fees (330 & 340). Change Number Revision Earliest Implementation IRR /15/2017 QCR20 8/15/2017 8/15/2018 IRR /15/2017 QCR21 8/15/2017 8/15/2018 IRR /15/2017 QCR22 8/15/2017 8/15/2018 IRR /15/2017 QCR23 8/15/2017 8/15/2018 IRR /15/2017 QCR24 8/15/2017 8/15/2018 IRR /15/2017 QCR25 8/15/2017 8/15/ /15/2017 QCR26 8/15/2017 8/15/2018 RE: Change Number EM15: Employer Paid TCs (2xx) and Acquired OTs (430 and 440) were removed from Payment Reason Codes EDI-Claims-R3.1.0_Quick-Code-Reference (Pub _Rev ) 4 IAIAC Change Log

5 Page 1 MAINTENANCE TYPE CODE (MTC's) (DN0002) OTHER ENEFIT TYPE CODE (OT's) (DN0216) FIRST REPORT: 300 Total Funeral Expenses 00 Original AQ Acquired Claim 310 Total Penalties 01 Cancel CO Correction 311 Total Employee Penalties 02 Change UI Under Investigation 320 Total Interest 04 Denial UR Upon Request 321 Total Employee Interest AU Acquired/Unallocated UR Update Report 330 Total Employer's Legal Expenses SUSEQUENT REPORT: 340 Total Claimant's Legal Expenses 02 Change PX Partial Suspension 350 Total Payments to Physicians 04 Denial R Reinstatement of enefit 360 Total Hospital Costs A Add Concurrent enefit Type RE Reduced Earnings 370 Total Other Medical AC Acquisition/Indemnity Ceased SU Sync Up 380 Total Vocational Rehabilitation Evaluation AP Acquired/Payment SX Full Suspension 390 Total Vocational Rehabilitation Education CA Change in enefit Amount UI Under Investigation 400 Total Other Vocational Rehabilitation C Change in enefit Type UR Upon Request 420 Total Expert Witness Fees CD Compensable Death - No Known Dependents/Payees UR Update Report 421 Total Court Reporter Fees CO Correction VE Volunteer 422 Total Private Investigator Fees EP Employer Paid AN Annual 430 Total Unallocated Prior Indemnity enefits ER Employer Reinstatement M i-monthly 440 Total Unallocated Prior Medical FN Final W i-weekly 450 Total Pharmaceutical Costs IP Initial Payment MN Monthly 455 Total Dental Expenses NT Narrative QT Quarterly 460 Total Physical Therapy Costs PD Partial Denial SA Sub-Annual 465 Total Chiropractic Expenses PY Payment Report Total Durable Medical Costs Total Medical Travel Expenses ENEFIT TYPE CODE (DN0085) 480 Total Employee Medical-Legal Costs REGULAR ENEFIT TYPES: LUMP SUM PAYMENTS/SETTLEMENTS: 485 Total Emplr/Clm Admin Med-Legal Costs 010 Fatal 500 Unspecified Lump Sum Pmt/Settlement 490 Total Agreed Upon/Directed Med-Legal Costs 020 Permanent Total 501 Medical Lump Sum Pmt/Settlement 021 Permanent Total Supplemental 510 Fatal Lump Sum Pmt/Settlement ENEFIT ADJUSTMENT CODE (DN0092) 030 Permanent Partial/Scheduled 520 Permanent Total Lump Sum Pmt/Settlement A Apportionment/Contribution 040 Permanent Partial/Unscheduled 521 Perm Total Supp Lump Sum Pmt/Settlement Subrogation 050 Temporary Total 524 Employer Paid Lump Sum Pmt/Settlement E Employer Provided Pension 051 Temporary Total Catastrophic 530 Perm Partial Sch Lump Sum Pmt/Settlement G Age 65 Reduction 070 Temporary Partial 540 Perm Partial Unsch Lump Sum Pmt/Settlement I Intoxication/Drugs 080 Employer's Liability 541 Voc Rehab Maint Lump Sum Pmt/Settlement J Appeal Adjustment 090 Permanent Partial Disfigurement 550 Temporary Total Lump Sum Pmt/Settlement L Disability Insurance/Income 210 Employer Paid Fatal enefits 551 Temp Total Cat Lump Sum Pmt/Settlement N Non-Cooperation: Rehab, Training, etc 220 Employer Paid Permanent Total enefits 570 Temporary Partial Lump Sum Pmt/Settlement Q Illegally Employed Minor 221 Employer Paid Permanent Total Supplemental enefits 580 Emprs Liability Lump Sum Pmt/Settlement R Social Security Retirement 230 Employer Paid Permanent Partial Scheduled 590 Perm Partl Disfigure Lump Sum Pmt/Settlement S Social Security Disability 240 Employer Paid (EP) Unspecified T Acceleration of enefits 242 EP Voc Rehab Maintenance INSURED TYPE CODE (DN0184) U Unemployment Compensation 250 EP Temporary Total I Insured V Safety Violation 251 EP Temp Total Catastrophic S Self-Insured W Partial Wage Continuation 270 EP Temporary Partial U Uninsured X Death enefit Reduction 410 Voc Rehab Maintenance INSURER TYPE CODE (DN0185) Y Z Partial Reimburse Clmt Atty Fees 2 Yrs Continuous Disability CLAIM TYPE CODE (DN0074) I Insurer 1 Cost of Living Adjustment N Notification of an Incident Only S Self-Insurer 2 Fraud/Misrepresentation M Medical Only G Guarantee Fund 3 Post Injury Wage Earning Capacity W Lost Time with No Paid Indemnity P Indemnity with No Lost Tme eyond Waiting Period LUMP SUM PAYMENT/SETTLEMENT CODE (DN0293) ENEFIT CREDIT CODE (DN0126) I Indemnity for Lost Time SF Settlement Full C Overpayment Credit L ecame Lost Time/Indemnity for Lost Time SP Settlement Partial M Credit for Employer Provided enefits in Excess ecame Medical Only AS AW Agreement Stipulated Award P of Covered Weekly enefit Advance TYPE OF LOSS CODE (DN0290) AD Advance 01 Traumatic Injury NS Non-Specified Lump Sum Payment ENEFIT REDISTRIUTION CODE (DN0130) 02 Occupational Disease H Court-Ordered Lien against WC 03 Cumulative Injury (other than disease) NON-CONSECUTIVE PERIOD CODE (DN0212) K Clmt Attorney Fees WAGE PERIOD CODE (DN0063) W Waiting Period enefit Period INITIAL TREATMENT CODE (DN0039) FROI: SROI: A Adjustment/Credit/Redistribution 0 No Medical Treatment 01 Weekly 01 Weekly 1 Minor On-Site Remedies by Employer 02 i-weekly 04 Monthly INJURY SEVERITY TYPE CODE (DN0229) 2 Minor Clinic/Hosp Remedies/Diagnostics 04 Monthly J Major/Medical Threshold 3 Emergency Evaluation, Diagnostic Testing, 06 Daily M Minor and Medical Procedures 07 Hourly Suspension Reason Code Full (DN0418) 4 5 Hospitalization > 24 hours Future Major Med/Lost Time Anticipated DEPENDENT EXTENT OF DEPENDENCY (DN0429) S1 Suspension, RTW or Medically F P Full dependency Partial dependency S2 Determined/Qualified to RTW Suspension, Medical Non-Compliance A PARTIAL DENIAL CODE (DN0294) Denying Indemnity in Whole, not Medical S3 Suspension, Administrative Non-Compliance Denying Indemnity in Part, not Medical DEPENDENT/PAYEE RELATIONSHIP CODE (DN0097) S4 Suspension, Claimant Death C Denying Medical in Whole, Not Indemnity R Relationship S5 Suspension, Incarceration D Denying Medical in Part, Not Indemnity 2 Widow S6 Suspension, Claimant's Whereabouts Unknown E Denying Indemnity in Whole, Medical in Part 3 Widower S7 Suspension, enefits Exhausted F Denying Medical in Whole, Indemnity in Part 4 Son/Daughter S8 Suspension, Jurisdiction Change G Denying oth Indemnity & Medical in Part 5 rother/sister S9 Suspended Pending Settlement Approval 6 Mother/Father SD Suspension, Directed y Jurisdiction REDUCED ENEFIT AMOUNT CODE (DN0202) 7 Disabled Child SJ Suspended Pending Appeal or Judicial Review R Reclassification of enefit 8 Jurisdiction Fund/Estate S Claim Settled Under Another DOI 9 Other Suspension Reason Code - Partial (DN0419) N No Money Settlement N Numerical irth Order P1 Partial Suspension, RTW or Med D Decrease in Indemnity 0 Jurisdiction Fund Determined/Qualified to RTW F 15 P2 Partial Suspension, Medical Non-Compliance Part of ody Injured Location Code (DN0421) A 10 G 16 P3 Partial Suspension, Administrative ilateral 11 H 17 Non-Compliance L Left C 12 I 18 P4 Partial Suspension, Employee Death R Right D 13 J 19 P5 Partial Suspension, Incarceration E 14 K 20 P7 P9 Partial Suspension, enefits Exhausted Partial Suspension Pending Permanent Impairment ody Part Location Code (DN0432) ilateral INITIAL RTW TYPE CODE (DN0403) Settlement Approval L Left A Actual PJ Partial Suspension Pending R Right R Release Appeal or Judicial Review LATEST RTW TYPE CODE (DN0406) Part of ody Injured Fingers/Toes Location Code (DN0422) A Actual CHANGE REASON CODE (DN0413) 1 Index Finger or 1st Toe R Release A Add 2 Middle Finger or 2nd Toe CANCEL REASON CODE - (DN0400) U Update 3 Ring Finger or 3rd Toe D Duplicate/Combined Claim R Remove 4 Little Finger or 4th (little) Toe J Jurisdiction Wrong/Changed D Delete N R Not Required y Jurisdiction Disputed Request y Jurisdiction CAUSE OF INJURY CODE (DN0037) lepage.aspx NATURE OF INJURY CODE (DN0035) scriptiontablepage.aspx PART OF ODY INJURED CODE (DN0036) Page.aspx EDI-Claims-R3.1.0_Quick-Code-Reference (Pub _Rev ) 5 Page 1

6 Page 2 FULL DENIAL REASON CODE (DN0198) LATE REASON CODE (DN0077) 1 No Compensable Accident/Not in Course and Scope of Employment Delays A Coming and Going L1 No Excuse Horseplay L2 Late Notification, Employer C Willful Intent To Injure Oneself L3 Late Notification, Employee D Not Statutory Definition of Accident L4 Late Notification, Jurisdiction Transfer E Deviation From Employment L5 Late Notification, Health Care Provider F Recreational/Social Activity L6 Late Notification, Assigned Risk G Traveling Employee L7 Late Investigation H Subsequent Intervening Accident L8 Tech Processing Delay, Computer Failure I Presumption of compensability, as defined by juris., does not apply L9 Manual Processing Delay 2 No Causal Relationship LA Intermittent Lost Time Prior To 1st Pymnt A Idiopathic Condition L Late notification/payment due to a Natural Disaster Pre-existing Condition LC Late notification/payment due to an Act of Terrorism C Stress non-work related Coverage D No Medical Evidence of Injury C1 Coverage Lack Of Information E No Injury Per Statutory Definition Errors F Accident not major contributing cause of injury E1 Wrongful Determination of No Coverage 3 No Coverage E2 Errors From Employer A No Employee/Employer Relationship E3 Errors From Employee Independent Contractor E4 Errors From Jurisdiction C Not Statutory Definition of Employee E5 Errors From Health Care Provider D No Jurisdiction E6 Errors From Other Claim Admin/IA/TPA E No Policy in Effect On of Accident Disputes F Statute of Limitation Expired D1 Dispute Concerning Coverage G Statutory Exemptions (Sole Proprietor, Corporate Officer, etc. D2 Dispute Concern, Compensability in Whole H Elected Other Coverage (24 hr, Collective argaining, Opted Out) D3 Dispute Concern, Compensability in Part I Employee not reported to PEO D4 Dispute Concerning Disability in Whole 4 Substance Use/Abuse D5 Dispute Concerning Disability in Part A Injury Primarily Occasioned by Intoxication or Use of Any Drug D6 Dispute Concerning Impairment Substance Use/Abuse, Violation of Drug-Free Work Place Policy in effect 5 Other (Not Elsewhere Classified) ACCIDENT PREMISES CODE (DN0249) AGREEMENT TO COMPENSATE A Failure To Report Accident Timely E Employer CODE (DN0075) Right To Reserve L Lessee W Without Liability C Misrepresentation X Other L With Liability EMPLOYMENT STATUS CODE (DN0058) (In Hierarchical Order) EMPLOYEE GENDER CODE (DN0053) CLAIM STATUS CODE (DN0073) C Piece Worker M Male O Open 9 Volunteer Worker F Female C Closed 8 Seasonal Worker U Unknown R Re-Open A Apprenticeship Full-time X Re-Open/Closed 1 Apprenticeship Part-time Regular/Full-time Employee U EMPLOYEE MARITAL STATUS CODE (DN0054) Unmarried, Widowed, Divorced, Single DEATH RESULT OF 2 Part-time Employee M Married INJURY CODE (DN0146) 3 Unemployed/Not Employed S Separated Y Yes 6 Retired K Unknown N No 4 On Strike U Unknown 5 7 Disabled Other RECOVERY CODE (DN0226) Y N U PRE-EXISTING DISAILITY CODE (DN0069) Yes No Unknown A EMPLOYEE TAX FILING STATUS CODE (DN0158) Single 800 Special Fund Recovery Single/Head of Household 810 Deductibles Recovery MANAGED CARE ORGANIZATION (MCO) CODE (DN0207) C Married/Filing Joint 820 Subrogation Recovery 00 The claim is not administered by an approved/certified D Married/Filing Separate 830 Overpayment Recovery 01 The claim s medical losses are administered by an 840 Unspecified Recovery 02 The claim s medical losses are administered by a Health WORK WEEK TYPE CODE (DN0204) 845 Apportionment/Contribution Recovery 03 The claim s medical losses are administered by a Preferred S Standard Work Week 850 Second Injury Fund 04 The claim s medical losses are administered by an Exclusive F Fixed Work Week 860 Future Credit Amount 05 The claim s medical losses are administered by an V Varied Work Week 865 Vocational Rehabilitation 06 The claim is totally or partially covered by a Managed Care 866 Uninsured Employer 07 The claim's medical losses are administered by a Certified WORK DAYS SCHEDULED CODE (DN0205) 867 Silicosis, Dust & Logging Industry Fund EMPLOYEE ID TYPE QUALIFIER (DN0270) S Scheduled 868 Vocationally Handicapped Fund A Employee ID Assigned by Jurisdiction N Not Scheduled 870 Other Funds E Employee Employment Visa 880 Voided Indemnity enefit Check Recovery G Employee Green Card 890 Voided Other enefit Check Recovery P S Employee Passport Number Employee Social Security Number Payment Reason Code (DN0222) 010 Fatal 330 Total Employer's Legal Expenses 510 Fatal Lump Sum Pmt/Settlement 020 Permanent Total 340 Total Claimant's Legal Expenses 520 Permanent Total Lump Sum Pmt/Settlement 021 Permanent Total Supplemental 350 Total Payments to Physicians 521 Perm Total Supp Lump Sum Pmt/Settlement 030 Permanent Partial/Scheduled 360 Total Hospital Costs 524 Employer Paid Lump Sum Pmt/Settlement 040 Permanent Partial/Unscheduled 370 Total Other Medical 530 Perm Partial Sch Lump Sum Pmt/Settlement 050 Temporary Total 450 Total Pharmaceutical Costs 540 Perm Partial Unsch Lump Sum Pmt/Settlement 051 Temporary Total Catastrophic 455 Total Dental Expenses 541 Voc Rehab Maint Lump Sum Pmt/Settlement 070 Temporary Partial 460 Total Physical Therapy Costs 550 Temporary Total Lump Sum Pmt/Settlement 080 Employer's Liability 465 Total Chiropractic Expenses 551 Temp Total Cat Lump Sum Pmt/Settlement 090 Permanent Partial Disfigurement 470 Total Durable Medical Costs 570 Temporary Partial Lump Sum Pmt/Settlement 300 Total Funeral Expenses 500 Unspecified Lump Sum Pmt/Settlement 580 Emprs Liability Lump Sum Pmt/Settlement 310 Total Penalties 501 Medical Lump Sum Pmt/Settlement 590 Perm Partl Disfigure Lump Sum Pmt/Settlement 311 Total Employee Penalties APPLICATION ACKNOWLEDGMENT CODE (DN0111) TRANSACTION SET ID (DN0001) ACKNOWLEDGMENT TRANSACTION SET ID (DN0110) HD atch Rejected 148 First Report 148 First Report TA Transaction Accepted R21 First Report Companion Record A49 Subsequent Report TE Transaction Accepted with Error A49 Subsequent Report TN Transaction Rejected by Service Provider R22 Subsequent Report Companion Record INTERCHANGE VERSION ID (DN0105) TR Transaction Rejected AKC Claims Acknowledgment Detail Record First Report of Injury; Release 3, Version 0 ARC Claims Re-Acknowledgment Detail Record A4930 Subsequent Report of Injury; Release 3, Version 0 TEST/PRODUCTION CODE (DN0104) HD1 Transmission Header Record AKC30 Claims Acknowledgment Detail Record; Release 3, Vers P Production TR2 Transmission Trailer Record ARC30 Claims Re-Acknowledgment Detail Record; Release 3, V T Test (Pilot Parallel or Test) EDI-Claims-R3.1.0_Quick-Code-Reference (Pub _Rev ) 6 Page 2