Interim 837 Changes Issue Brief
|
|
- Lauren Dean
- 6 years ago
- Views:
Transcription
1 WEDI Strategic National Implementation Process (SNIP) s and Code Sets Workgroup 837 Subworkgroup Interim 837 s Issue Brief s for ASC X s: Version to TM 4/9/2015
2 Disclaimer This document is Copyright 2015 by The Workgroup for Electronic Data interchange (WEDI) and Accredited Standards Committee X12 (ASC X12). It may be freely redistributed in its entirety provided that this copyright notice is not removed. It may not be sold for profit or used in commercial documents without the written permission of the copyright holder. This document is provided as is without any express or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. If you require legal advice, you should consult with an attorney. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by the Workgroup for Electronic Data Interchange. The listing of an organization does not imply any sort of endorsement and the Workgroup for Electronic Data Interchange takes no responsibility for the products, tools, and Internet sites listed. The existence of a link or organizational reference in any of the following materials should not be assumed as an endorsement by the Workgroup for Electronic Data Interchange (WEDI), or any of the individual workgroups or subworkgroups of the WEDI Strategic National Implementation Process (WEDI SNIP). Document is for Education and Awareness Use Only Workgroup for Electronic Data Interchange 1984 Isaac Newton Square, Suite 304, Reston, VA T: /F: Accredited Standards Committee X Greensboro Drive, Suite 800, McLean, VA T: /F:
3 CONTENT Disclaimer I. Introduction II. III. Purpose of this Issue Brief Scope IV. s in ASC X s from 5010 to 6020 V. Conclusion VI. Acknowledgements
4 I. Introduction As part of their normal standards development process, the Accredited Standards Committee X12 (ASC X12), continues to update their standards on an ongoing basis. These updates are not to be used until the Department of Health and Human Services (HHS) adopts them as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard through regulation. The last adopted version was Version ( 5010 ), which continues to be used today as required. A subsequent version of the ASC X12 Insurance Subcommittee (ASC X12N) transactions, Version TM ( 6020 ), was developed and released for public comment, but was not brought forward for adoption under HIPAA. ASC X12N is currently working on the next version of transactions after 6020 TM. Version 6020 will be the starting point for the next version and will be updated to reflect new requirements for transactions. Members of the industry have expressed interest in understanding changes that have been made to the health care claims transactions between versions 5010 and Providing information on these changes will give organizations an opportunity to assess the potential future system changes they may need to make when the next version of the standards is adopted under HIPAA. NOTE: VERSION 5010 OF THE TRANSACTIONS REMAINS THE ADOPTED VERSION FOR USE. NO CHANGES TO THE CLAIM TRANSACTIONS NEED TO BE MADE UNTIL A NEW VERSION OF THE TRANSACTIONS IS ADOPTED THROUGH REGULATION UNDER HIPAA. The current HIPAA adopted transactions that must continue to be used are: Version 5010 X222A1 Health Care Professional (837) Version 5010 X223A2 Health Care Institutional (837) Version 5010 X224A2 Health Care Dental (837) II. Purpose of this Issue Brief The purpose of this issue brief is to provide information on changes made in the ASC X12N health care claim transactions between versions 5010 and These changes may indicate potential future system modifications. Organizations may wish to use the information provided in this issue brief for internal review and planning. They can also use this information to better understand why changes were made in the ASC X12N version These changes are expected to remain in future versions that may be adopted under HIPAA. Note: The purpose of this issue brief is not to duplicate any change logs that will be developed by ASC X12. III. Scope This issue brief is limited to the following ASC X12N Technical Reports: Version 5010 X222A1 Health Care Professional (837) Version 5010 X223A2 Health Care Institutional (837) Version 5010 X224A2 Health Care Dental (837) Version 6020 X259 Health Care Professional (837)
5 Version 6020 X260 Health Care Institutional (837) Version 6020 X261 Health Care Dental (837) The changes identified in this issue brief are limited to those in the health care claim transactions between the HIPAA-adopted version 5010 and ASC X12N public comment version Not all changes between versions 5010 and 6020 of the claims transactions are included in this issue brief. The changes included are the ones that the WEDI 837 Subworkgroup identified as having a potential impact on organizations.
6 IV. s in ASC X s from 5010 to 6020 Billing Address Billing And Service Facility Location Relaxed requirement for 9-digit ZIP code for Billing and Service Facility Location Reason for It was determined that not all addresses have a 9-digit ZIP code, so the requirement to report a 9- digit ZIP code was relaxed. Potential Future System s s will need to remove any defaults currently in place to satisfy the 9-digit requirement. s with a 9-digit ZIP code will need to understand from their payers how claims will be handled if they are submitted with a 5-digit ZIP code. Will claims be rejected? Pay-to Factoring Agent Billing New loop Reporting of this information was added based on the business model in which an entity takes over the collection management of claims from a payer. This entity needs to be identified separately in the claim, when applicable. Payers, clearinghouses, validation software vendors, and other organizations that edit and accept claims will need to review their edit rules for when to require a 9-digit ZIP code or allow a 5-digit ZIP code. They will also need to update any necessary programming and instructions for providers on reporting of ZIP codes. s will need to be able to accommodate reporting this information, when necessary. This business model is currently seen more frequently in the property and casualty area.
7 Diagnosis Pointer Increased the number of diagnosis pointers that can be reported at the service line Reason for A need was identified to be able to point to up to 12 diagnosis codes at the service line level. will decrease the need to split claims when more than 4 diagnosis codes need to be pointed to for a service line. Potential Future System s senders and receivers of claims will need to update their systems to accommodate up to 12 diagnosis pointers at the service line level. The 1500 claim form will continue to only allow 4 diagnosis pointers, so the paper form and will be out of alignment for this data. Agreement Code Data was removed in 5010, but added back in 6020 A need was identified to add back the reporting of a Agreement Code to identify when a non-participating provider is submitting a participating claim. The 1500 claim form uses alpha characters for the diagnosis pointers and the uses numbers, this means that additional mapping is needed for converting the paper form to the and vice versa. The will not be changing from numbers to alpha characters. senders and receivers of claims will need to update their systems to accommodate reporting of this data. Medicare Assignment Code Situational note changed in 6020 limiting reporting requirements Definition was changed between 5010 and 6020 A note has been added to say this data is not reported in claims bound for Medicare. In 4010, this element applied only to Medicare. d in 5010 to apply to other payers beyond Medicare. The situational note has been changed back in 6020 to apply only to Medicare claims. More notes have been added to the TR3 on its usage. Senders and receivers will need to review and update their mapping of the data element. See Other Insurance Coverage for additional information on how to report this value on COB claims.
8 Predetermination New in the 837I and TR3s 837I Reason for Added an indicator to identify that the transaction is a predetermination request vs. claim being submitted for payment. Potential Future System s The addition of this to the and 837I does not make it a HIPAA mandated business function that must be supported by payers. Original Creation Date Added new segment to the claim to carry the actual date the claim was created out of the provider system Predetermination transaction was a separate TR3 in Added to help with establishing timeline of claim creation. their systems to accommodate this data, if allowed. their systems to add this information. s will need to make sure they are creating this date when they submit a claim. Downstream trading partners will need to carry this date forward in later processing. Set Creation Date Header Removed note stating that this date is submitter creation date Problems were identified with the use of this element, which were addressed by adding the original claim creation date. Date was being overlaid by trading partners for the date they transmitted the claim out of their system, which then impacted identifying the original creation date. If claim is dropped to paper at any point in the processing, then date would be lost. Senders other than the original submitter and receivers will need to update their systems to accommodate this change. Needed to address the date generated during the various hops and which one to use to establish timely filing.
9 Procedure Modifiers Procedure Modifiers Tooth Numbers Line Adjudication Expanded number of modifiers that can be reported per procedure code from 4 to 8 Expanded number of modifiers that can be reported per procedure code from 4 to 8 Added the ability to report tooth numbers Reason for A need was identified to send more than 4 modifiers per procedure at the line level. In 5010, additional extra modifiers beyond 4 are being sent in the notes. Was added to provide consistency with the information. A need was identified to report tooth numbers for procedures that are billed on the instead of the 837D. Potential Future System s Updates will need to be made to current edit logic to address not being able to send a 5 th modifier without a 4 th, etc. Senders will need to update their systems to be able to send more than 4 modifiers. Receivers will need to update their systems to accept more than 4 modifiers. Updates will need to be made to accommodate the COB line adjudication information explaining what was paid on. Updates will need to be made to current edit logic to address not being able to send a 5 th modifier without a 4 th, etc. Family Planning Indicator d from situational to required A work-around solution was developed for reporting tooth numbers in made to comply with ASC X12 semantic note for the yes/no condition or response code. Previously only populated for Yes and will now need to be populated for yes and no EPSDT d from situational to required made to comply with ASC X12 semantic note for the yes/no condition or response code. Previously only populated for Yes and will now need to be populated for yes and no
10 Purchased Service Amount Drug al Remark Codes Service Adjustment Line Adjudication Other Subscriber and Line Adjudication Removed the purchased service information and added an amount element for reporting the data Added the ability to report additional drug service and adjudication information at the service line level New data elements added to allow for reporting of informational remark codes not associated with Adjustment Reason Codes (CARC) Replaced line adjustment (CAS) with service adjustment information (RAS) Reason for The data reported in the purchase service information segment was not needed except for the dollar amount. The segment was removed and ability to report the purchased service amount was added in an element. Two segments were added to report additional drug information for drug rebate programs. The requirements within the segments align with the current NCPDP Telecommunications Standard Implementation Guide. was made to align requirements with the Health Care Payment/Advice (835). Enabled the ability to link the CARC with the Reason and Remark Codes (RARC). Potential Future System s Will impact COB claims. Will have issues with accommodating RAS if translating a to a , because there is no place for the RARCs to be reported.
11 Secondary Identifiers Loops And Removed qualifier Commercial Number (G2) and added Identifier (A6) Reason for A need was identified to have a more generic qualifier for all payer assigned identifiers. Potential Future System s Condition Codes Dental Readiness Classification Code Billing Secondary Identification in the Payer Loop added 837D HI segment (Qualifier BG) New REF segment added Payer ID Payer d from Required to Situational Assigned Identifier d implementation name from Patient Control Number to Assigned Identifier. d maximum character length from 20 to D Reporting of this information is specific to worker s comp claims. Added for TRICARE Active Duty Dental Program Required for claims, not predeterminations. Provided a consistent location of the payer ID within the 837 transaction. To provide clarification on the intended use of this data element.
12 Admission Date Modified the situational rule to allow at the sender s discretion. Reason for To provide clarification on the intended use of this segment. Potential Future System s Principle Diagnosis Code Qualifier Sales Tax Amount d wording from inpatient medical visits to inpatient hospital services Removed qualifiers ABK (ICD-10) and BK (ICD-9) from Health Care Diagnosis Code HI Segment Removed this AMT segment Eliminated because diagnosis codes are reported in the order of importance based on the diagnosis code pointer in the SV107. Eliminated the ability to report this content two ways. This amount can be sent at the service line using a CPT/HCPCS code.
13 V. Conclusion The Subworkgroup will continue to evaluate the impact of these changes and will consider development of additional issue briefs in the future. VI. Acknowledgements Kelly Butler, Emdeon (WEDI representative) Gloria Davis, NextGen (WEDI representative) Rose Hodges, Aetna (ASC X12 representative) Jamie Mosteller, Cerner (ASC X12 representative) Nancy Spector, American Medical Association (WEDI representative) The co-chairs wish to express their sincerest thanks and appreciation to the members of the 837 Subworkgroup who participated in the creation of this document.
NPI Utilization in Healthcare EFT Transactions March 5, 2012
WEDI Strategic National Implementation Process (SNIP) WEDI SNIP Transactions Workgroup EFT Subworkgroup EFT NPI Utilization Issue Brief NPI Utilization in Healthcare EFT Transactions March 5, 2012 Workgroup
More informationWEDI Strategic National Implementation Process (SNIP) Transaction Workgroup 835 Subworkgroup Overpayment Recovery 5010 Education December, 2013
WEDI Strategic National Implementation Process (SNIP) Transaction Workgroup 835 Subworkgroup Overpayment Recovery 5010 Education December, 2013 Workgroup for Electronic Data Interchange 1984 Isaac Newton
More informationKY Medicaid. 837P Companion Guide. Cabinet for Health and Family Services Department for Medicaid Services. March 28, 2017 KY MEDICAID COMPANION GUIDE
KY Medicaid 837P Companion Guide Cabinet for Health and Family Services Department for Medicaid Services March 28, 2017 DMS Approved [2017 005010] 1 Document Change Log Version Changed Date Changed By
More informationIndiana Health Coverage Programs
Indiana Health Coverage Programs Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Health Care Claim: Institutional
More informationStandard Companion Guide Transaction Information. Instructions related to Transactions based on ASC X12 Implementation Guides, Version
County Medically Indigent Services Program (CMISP), Physicians Emergency Medical Services (PEMS), and Non-contracted Hospital ER Services Policy (NHERSP) Standard Companion Guide Transaction Information
More informationKY Medicaid. 837I Companion Guide. Cabinet for Health and Family Services Department for Medicaid Services. March 28, 2017 KY MEDICAID COMPANION GUIDE
KY Medicaid 837I Companion Guide Cabinet for Health and Family Services Department for Medicaid Services March 28, 2017 DMS Approved 2017 005010 1 Document Change Log Version Changed Date Changed By Reason
More informationIndiana Health Coverage Programs
Indiana Health Coverage Programs Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Health Care Claim: Dental (837)
More informationWEDI SNIP Claredi EDI Edit Description Claim Type 837P 837I. 1 H10006 Value is too long X X
EDI Claim Edits UnitedHealthcare applies Health Insurance Portability and Accountability Act (HIPAA) edits for professional (837p) and institutional (837i) claims submitted electronically. Enhancements
More information13. IEHP P PROFESSIONAL CLAIM COMPANION GUIDE A. Included ASC X12 Implementation Guides X222A1 Health Care Claim: Professional
13. IEHP 5010 837P PROFESSIONAL CLAIM COMPANION GUIDE 1. 005010X222A1 Health Care Claim: Professional Standard Companion Guide (CG) Transaction Information Effective January 1, 2018 IEHP Instructions related
More informationIndiana Health Coverage Programs
Indiana Health Coverage Programs Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Health Care Claim: Institutional
More information835 Health Care Claim Payment/ Advice Companion Guide
835 Health Care Claim Payment/ Advice Companion Guide Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Companion
More information837P Health Care Claim Companion Guide
837P Health Care Claim Companion Guide Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Companion Guide Version
More informationKY Medicaid. 837 Dental Companion Guide. Cabinet for Health and Family Services Department for Medicaid Services
KY Medicaid 837 Dental Companion Guide Cabinet for Health and Family Services Department for Medicaid Services March 28, 2017 Document Change Log Version Changed Date Changed By Reason 2.0 11/02/2011 Kathy
More informationRefers to the Technical Reports Type 3 Based on ASC X12 version X279A1
HIPAA Transaction Standard Companion Guide Refers to the Technical Reports Type 3 Based on ASC X12 version 005010X279A1 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide Version
More informationVendor Specifications 837 Institutional Claim ASC X12N Version X223A2. for. State of Idaho MMIS
Vendor Specifications 837 Institutional Claim ASC X12N Version 005010X223A2 for State of Idaho MMIS Date of Publication: 6/16/2016 Document Number: TL426 Version: 8.0 Revision History Version Date Author
More information837I Health Care Claim Companion Guide
837I Health Care Claim Companion Guide Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Companion Guide Version
More informationVendor Specifications 837 Professional Claim ASC X12N Version for. State of Idaho MMIS
Vendor Specifications 837 Professional Claim ASC X12N Version 5010 for State of Idaho MMIS Date of Publication: 12/8/2017 Document Number: TL427 Version: 11.0 Revision History Versio Date Author Action/Summary
More informationWEDI Strategic National Implementation Process (SNIP) Payment Models Workgroup Bundled Payments Taskforce. Bundled Payments Issue Brief
WEDI Strategic National Implementation Process (SNIP) Payment Models Workgroup Bundled Payments Taskforce Bundled Payments Issue Brief March 26, 2015 Workgroup for Electronic Data Interchange 1984 Isaac
More informationKY Medicaid. 837P Companion Guide. Cabinet for Health and Family Services Department for Medicaid Services. August 1, 2017 KY MEDICAID COMPANION GUIDE
KY Medicaid 837P Companion Guide Cabinet for Health and Family Services Department for Medicaid Services August 1, 2017 DMS Approved [2017 005010] 1 Document Change Log Version Changed Date Changed By
More informationMinnesota Department of Health (MDH) Rule
Minnesota Department of Health (MDH) Rule Title: Pursuant to Statute: Minnesota Uniform Companion Guide (MUCG) for the ASC X12/005010X224A2 Health Care Claim: Dental (837) Version 12 Minnesota Statutes
More informationGeisinger Health Plan
Geisinger Health Plan Companion Guide for the 834 Benefit Enrollment and Maintenance Refers to the Implementation Guides Based on X12 version 005010X220 Version Number: 1.01 Revised, October 28, 2010 1
More informationX12N/005010X220A1Benefit Enrollment and Maintenance (834) and the X12N/005010X221A1 Health Care Claim Payment/Advice (835) QUESTIONS AND ANSWERS
X12N/005010X220A1Benefit Enrollment and Maintenance (834) and the X12N/005010X221A1 Health Care Claim Payment/Advice (835) QUESTIONS AND ANSWERS Version 1.2 March 2017 National Council for Prescription
More informationVIII STANDARD ENCOUNTER COMPANION GUIDE A. Transaction Introduction
A. Transaction Introduction Standard Companion Guide (CG) Transaction Information Effective March 27, 2015 IEHP Instructions related to Implementation Guides (IG) based On X12 Version 005010X222A1 Health
More informationANSI ASC X12N 837P Health Care Claim Professional. TCHP Companion Guide
ANSI ASC X12N 837P Health Care Claim Professional TCHP Companion Guide Published: July 20, 2016 Contents Purpose... 3 Security and Privacy Statement... 3 Overview of HIPAA Legislation... 3 Compliance according
More informationP R O V I D E R B U L L E T I N B T J U N E 1,
P R O V I D E R B U L L E T I N B T 2 0 0 5 1 1 J U N E 1, 2 0 0 5 To: All Providers Subject: Overview The purpose of this bulletin is to provide information about system modifications that are effective
More informationIAIABC EDI IMPLEMENTATION GUIDE
IAIABC EDI IMPLEMENTATION GUIDE for MEDICAL BILL PAYMENT RECORDS RELEASE 1.1 JULY 1, 2009 EDITION INTERNATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS This page is meant to be blank.
More informationVersion Number: 1.0 Introduction Matrix Wellmark Values. November 01, 2011
Wellmark Blue Cross and Blue Shield HIPAA Transaction Standard Companion Guide Section 2, 837 Institutional Refers to the X2N Technical Report Type 3 ANSI Version 500A2 Version Number:.0 Introduction Matrix
More informationHIPAA Readiness Disclosure Statement
HIPAA Readiness Disclosure Statement Blue Cross of California and its affiliates have been diligently following the evolution of the Administrative Simplification provisions of the Health Insurance Portability
More informationSecondary Claim Reporting Considerations
Secondary Claim Reporting Considerations Question: How is the 005010X221 Health Care Claim Payment/Advice (835) supposed to be populated by a non-primary payer when one or more other payers have already
More informationStandard Companion Guide
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X221A1 Health Care Claim Payment/Advice (835) Companion Guide Version Number: 2.0 February 2018 Page 1 of 13 CHANGE
More informationWhat Regulatory Requirements are Responsible for the Transactions Standards?
Versions 5010 Why the Change? 99% of Medicare Part A and 96% of Part B Claims are submitted electronically New Accreditations standards adopted with Electronic Medical Records must align with the submitted
More informationKyHealth Choices MMIS Batch Health Care Dental Health Care Claim and Encounter Claims (837D) Companion Guide Version 2.0 Version X097A1
KyHealth Choices MMIS Batch Health Care Dental Health Care Claim and Encounter Claims (837D) Companion Guide Version 2.0 Version 004010 X097A1 Cabinet for Health and Family Services Department for Medicaid
More informationElectronic Claim Adjustments User Guide
Electronic Adjustments User Guide azblue.com 251405-16 Electronic Adjustments User Guide Contents Introduction... 1 Request for reconsideration or adjustment of adjudicated claims... 1 Appeals and grievance
More informationDebbi Meisner, VP Regulatory Strategy
Jan April July Oct Jan April July Oct Jan April July Oct Jan April July Oct Debbi Meisner, VP Regulatory Strategy HIPAA and ACA Timeline 2013 2014 2015 2016 1/1/2013 Eligibility & Claim Status Operating
More informationNational Uniform Claim Committee
National Uniform Claim Committee 02/12 1500 Claim Form Map to the X12 Health Care Claim: Professional (837) August 2018 The 1500 Claim Form Map to the X12 Health Care Claim: Professional (837) includes
More informationHealth Care Claim: Institutional (837)
Health Care Claim: Institutional (837) Standard Companion Guide Transaction Information November 2, 2015 Version 3.1 Express permission to use ASC X12 copyrighted materials within this document has been
More informationUSVI HEALTH CARE CLAIM 837 Companion Guide. Version 0.1 February 6, 2013
USVI HEALTH CARE CLAIM 837 Companion Version 0.1 February 6, 2013 Table of Contents 1.0 COMPANION GUE PURPOSE... 4 2.0 ATYPICAL PROVERS... 4 3.0 CONTROL STRUCTURE DEFINITIONS... 5 3.1 ISA - INTERCHANGE
More informationKyHealth Choices MMIS Batch Health Care Institutional Health Care Claim and Encounter Claims (837I) Companion Guide Version 3.0 Version X096A1
KyHealth Choices MMIS Batch Health Care Institutional Health Care Claim and Encounter Claims (837I) Companion Guide Version 3.0 Version 004010 X096A1 Cabinet for Health and Family Services Department for
More information270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide
270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides,
More informationTexas Children s Health Plan. HIPAA 5010 Compliancy Plan STAR & CHIP. January 4, Version 1.1
Texas Children s Health Plan HIPAA 5010 Compliancy Plan STAR & CHIP January 4, 2010 Version 1.1 Exhibit 4.3.14-U Page 1 Background: The Workgroup on Electronic Data Interchange (WEDI) released its specifications
More informationBenefit Enrollment and Maintenance (834) Change Log:
ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 Benefit Enrollment and Maintenance (834) Change Log 005010-007030 SEPTEMBER 2016 SEPTEMBER 2016 1 Intellectual Property Accredited
More informationThe benefits of electronic claims submission improve practice efficiencies
The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer
More informationCompanion Guide for the X223A2 Health Care Claim: Institutional (837I) Lines of Business: Private Business Senior Plans QUEST Blue Card FEP AFHC
Companion Guide for the 005010X223A2 Health Care Claim: Institutional (837I) Lines of Business: Private Business Senior Plans QUEST Blue Card FEP AFHC Segment Loop Name TR3 Values Notes Delimiter: Data
More informationBest Practice Recommendation for
Best Practice Recommendation for Exchanging Explanation of Payment Information between Providers and Health Plans (using 5010v transactions) For use with ANSI ASC X12N 5010v Health Care Claim (837) Health
More informationBOOKLET. Reading A Professional Remittance Advice (RA) Target Audience: Medicare Fee-For-Service Program (also known as Original Medicare)
PRINT-FRIENDLY VERSION BOOKLET Reading A Professional Remittance Advice (RA) Target Audience: Medicare Fee-For-Service Program (also known as Original Medicare) The Hyperlink Table at the end of this document
More informationSeg Loop Name TR3 Values Notes Delimiter: Data Element. (:) Colon Separator
Companion Guide for the 005010X223A1 Health Care Claim: Institutional (837I) Lines of Business: Private Business, 65C Plus, QUEST, Blue Card, FEP, Away From Home Care Delimiter: Data Element (*) Asterisk
More informationVendor Specifications 278 Healthcare Services Request for Review and Response ASC X12N Version for. State of Idaho MMIS
Vendor Specifications 278 Healthcare Services uest for Review and Response ASC X12N Version 5010 for State of Idaho MMIS Date of Publication: 07/25/2017 Document Number: TL418 Version: 5.0 Revision History
More informationHIPAA 837I (Institutional) Companion Guide
Companion Guide Prepared for Health Care Providers For use with the Cardinal Innovations claims processing system Version 5.0 January 2011 Table of Contents 1. Introduction...3 2. Approval Procedures...4
More information837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More informationARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) Companion Document and Transaction Specifications for HIPAA 837 Claim Transactions
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) Companion Document and Transaction Specifications for HIPAA 837 Claim Transactions VERSION 1.4 JUNE 2007 837 Claims Companion Document Revision History
More informationTexas Medicaid. HIPAA Transaction Standard Companion Guide
Texas Medicaid HIPAA Transaction Standard Companion Guide Refers to the Implementation Guide Long Term Care 837 Health Care Claim: Institutional Based on ASC X12 version 005010 CORE v5010 Companion Guide
More information837 Professional Health Care Claim Outbound. Section 1 837P Professional Health Care Claim: Basic Instructions
Companion Document 837P 837 Professional Health Care Claim Outbound This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and
More informationERA Claim Adjustment Reason Code Mapping
ERA Claim Adjustment Reason Code Mapping 1 Disclaimer Conference presentations are intended for educational purposes only and do not replace independent professional judgment. Statements of fact and opinions
More informationClaims Resolution Matrix Professional
Rev 04/07 Claims Resolution Matrix Professional This Claims Resolution Matrix is to be used as a reference tool to troubleshoot professional claims that have been submitted electronically (i.e., submitted
More informationChapter 19 Section 2. Health Insurance Portability And Accountability Act (HIPAA) Standards For Electronic Transactions
Health Insurance Portability and Accountability Act (HIPAA) of 1996 Chapter 19 Section 2 Health Insurance Portability And Accountability Act (HIPAA) Standards For Electronic Transactions Revision: 1.0
More informationBest Practice Recommendation for. Processing & Reporting Remittance Information ( v) Version 3.93
Best Practice Recommendation for Processing & Reporting Remittance Information (835 5010v) Version 3.93 For use with ANSI ASC X12N 835 (005010X222) Health Care Claim Payment/Advice Technical Report Type
More information837 Professional Health Care Claim - Outbound
Companion Document 837P 837 Professional Health Care Claim - Outbound Basic Instructions This section provides information to help you prepare for the ANSI ASC X12N 837 Health Care transaction for professional
More informationPhase III CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule version 3.0.
Phase III CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule *NOTE: This document is not the most current version of the CORE Code Combinations. The current
More informationNational Electronic Data Interchange Transaction Set Companion Guide Health Care Claims Institutional & Professional 837 ASC X12N 837 (005010)
National Electronic Data Interchange Transaction Set Companion Guide Health Care Claims Institutional & Professional 837 ASC X12N 837 (005010) DMC Managed Care Claims - Electronic Data Interchange Strategy
More information837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More information837I Institutional Health Care Claim - for Encounters
Companion Document 837I - Encounters 837I Institutional Health Care Claim - for Encounters Basic Instructions This section provides information to help you prepare for the ANSI ASC X12N 837 Health Care
More informationSubmitting Secondary Claims with COB Data Elements - Facilities
Overview Submitting Secondary Claims with COB Data Elements - Facilities This supplement to the billing section of the AmeriHealth Caritas Pennsylvania Claims Filing Instruction Manual provides specific
More informationNational Uniform Claim Committee
National Uniform Claim Committee 1500 Claim Form Map to the X12 837 Health Care Claim: Professional November 2008 The 1500 Claim Form Map to the X12 837 Health Care Claim: Professional includes data elements,
More informationClaims Resolution Matrix Professional
Rev 04/07 Claims Resolution Matrix Professional This Claims Resolution Matrix is to be used as a reference tool to troubleshoot professional claims that have been submitted electronically (i.e., submitted
More informationHIPAA Transaction Companion Guide 837 Professional Health Care Claim
HIPAA Transaction Companion Guide 837 Professional Health Care Claim Refers to the Implementation Guides Based on X12 version 005010 Companion Guide Version Number: 1.2 August 2017 Disclaimer Statement
More informationHIPAA Transaction Standard Companion Guide 834 Eligibility Enrollment and Maintenance
HIPAA Transaction Standard Companion Guide 834 Eligibility Enrollment and Maintenance Refers to the Implementation Guides Based on X12 version 005010 Errata Companion Guide Version Number: 2.1 June 21,
More informationEDI 5010 Claims Submission Guide
EDI 5010 Claims Submission Guide In support of Health Insurance Portability and Accountability Act (HIPAA) and its goal of administrative simplification, Coventry Health Care encourages physicians and
More information5010 Simplified Gap Analysis Professional Claims. Based on ASC X v5010 TR3 X222A1 Version 2.0 August 2010
5010 Simplified Gap Analysis Professional Claims Based on ASC X12 837 v5010 TR3 X222A1 Version 2.0 August 2010 This information is provided by Emdeon for education and awareness use only. Even though Emdeon
More informationPurpose of the 837 Health Care Claim: Professional
Oklahoma Medicaid Management Information System Interface Specifications 837 Professional Health Care Claim HIPAA Guidelines for Electronic Transactions Companion Document The following is intended to
More informationHIPAA Electronic Transactions & Code Sets
P R O V II D E R H II P A A C H E C K L II S T Moving Toward Compliance The Administrative Simplification Requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will have
More information5010: Frequently Asked Questions
5010: Frequently Asked Questions ICD 10 Hub: 5010 FAQ Page 1 Table of Contents If you are viewing this document on your computer, simply hold down your Control button and click on the question to be taken
More informationClaims Resolution Matrix Institutional
Rev /07 Claims Resolution Matrix Institutional This Claims Resolution Matrix is to be used as a reference tool to troubleshoot institutional claims that have been submitted electronically (i.e., submitted
More informationAppendix 3B. Crosswalk from Retired Minimum Data Element List to Appendix 3A MA Companion Guide
Appendix 3B. Crosswalk from Retired Minimum Data Element List to Appendix 3A MA A3B.1 LOOPS AND SEGMENTS APPLIED TO EDR AND CRR SUBMISSIONS... 3 A3B.2 COLUMN HEADING CROSSWALK FROM APPENDIX 3A MA COMPANION
More informationRev 7/20/2015. ClaimsConnect Rejection Guide
ClaimsConnect Rejection Guide Helper Client, The purpose of this document is to assist you in accelerating the resolution of claim rejections. We have identified the most frequent rejection messages, and
More informationCLAIMS Section 6. Provider Service Center. Timely Claim Submission. Clean Claim. Prompt Payment
Provider Service Center Harmony has a dedicated Provider Service Center (PSC) in place with established toll-free numbers. The PSC is composed of regionally aligned teams and dedicated staff designed to
More informationUpdate: Electronic Transactions, HIPAA, and Medicare Reimbursement
McMahon HIPAA Update 521 Pain Physician. 2003;6:521-525, ISSN 1533-3159 Practice Management Update: Electronic Transactions, HIPAA, and Medicare Reimbursement Erin Brisbay McMahon, JD Physician practices
More informationADJ. SYSTEM FLD LEN. Min. Max.
Loop Loop Repeat Segme nt Element Id Description X12 Page No. ID Min. Max. ADJ. SYSTEM FLD LEN Usage Req. ANSI VALUES COMMENTS 1 ISA Interchange Control Header B.3 1 R ISA08 Interchange Receiver ID AN
More informationHIPAA Transaction Testing
HIPAA Transaction Testing Transactions@concio.com October, 2002 Julie A. Thompson Alliance Partners Agenda HIPAA Transaction Overview A whole new world Transaction Analysis The steps in the process Transaction
More informationHIPAA Glossary of Terms
ANSI - American National Standards Institute (ANSI): An organization that accredits various standards-setting committees, and monitors their compliance with the open rule-making process that they must
More informationGroup Minutes X12N TG2 WG02 Health Care Claims September 24-28, 2006
Group Minutes X12N TG2 WG02 Health Care Claims September 24-28, 2006 Chair(s) Name Company Term End Date Phone Email John Bock Individual Member After February Ph: 518-257-4484 jbock@prodigy.net 2008 meeting
More informationCalifornia Division of Workers Compensation Medical Billing and Payment Guide. Version
California Division of Workers Compensation Medical Billing and Payment Guide Version 1.2 1.2.1 Table of Contents Introduction --------------------------------------------------------------------------------------------------------------ii
More informationANSI ASC X12N 837P Health Care Claim Professional. TCHP Companion Guide
ANSI ASC X12N 837P Health Care Claim Professional TCHP Companion Guide Updated: October 10, 2017 Contents Purpose... 3 Security and Privacy Statement... 3 Overview of HIPAA Legislation... 3 Compliance
More information837 Institutional Health Care Claim Outbound. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More information837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More informationHIPAA 5010 Webinar Questions and Answer Session
HIPAA 5010 Webinar Questions and Answer Session Q: After Jan 2012, do the providers who bill on paper have to worry about 5010? Q: What if a provider submits all claims via paper? Do the new 5010 guidelines
More informationFlorida Blue Health Plan
Florida Blue Health Plan HIPAA Transaction Standard Companion Guide For Availity Health Information Network Users Refers to the Technical Reports Type 3 Based on ASC X12 version 005010X222A1 837I Health
More informationHIPAA 5010 Frequently Asked Questions
HIPAA 5010 Frequently Asked Questions Table of Contents 1. Navicure s Online Claim Form........5 Q: Will the format change on Navicure s online HCFA 1500 claim form?... 5 2. General 5010 Questions.............5
More informationFallon Health. 835 Fallon Health Companion Guide. Health Care Payment Advice. 835 Companion Guide
Fallon Health Health Care Payment Advice 835 Companion Guide Refers to the ASC X12N 835 Technical Report Type 3 Guide (Version 005010X221A1) Companion Guide Version Number: 1.3 October 2017 1 Disclosure
More information837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES. Administrative Simplification: Adoption of a Standard for a Unique Health Plan
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 45 CFR Part 162 [CMS-0040-F] RIN 0938-AQ13 Administrative Simplification: Adoption of a Standard for a Unique Health Plan
More information835 Health Care Claim Payment/Advice
Companion Document 835 835 Health Care Claim Payment/Advice Basic Instructions This section provides information to help you prepare for the ANSI ASC X12 Health Care Claim Payment/Advice (835) transaction.
More informationStandard Companion Guide
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X279A1 Health Care Eligibility Benefit Inquiry and Response (270/271) Companion Guide Version Number 3.0 November
More informationMEMORANDUM. DATE: February 5, Participating Providers. FROM: Network Management Services
MEMORANDUM DATE: February 5, 2014 TO: Participating Providers FROM: Network Management Services RE: CMS 1500 Form Version 02/2012 Mandated as of April 1, 2014 Dear Participating Provider, We are pleased
More informationStandards and Operating Rules for Electronic Funds Transfer and Claims Payment/Remittance Advice. 2010, Data Interchange Standards Association
Standards and Operating Rules for Electronic Funds Transfer and Claims Payment/Remittance Advice 2010, Data Interchange Standards Association Overview Our Role and expertise in the Remittance Advice Transaction
More information834 Benefit Enrollment and Maintenance
New Mexico Health Insurance Exchange (NMHIX) 834 Benefit Enrollment and Maintenance Standard Companion Guide Transaction Information Version 1.5 06/17/2014 PREFACE This Companion Guide to the v5010 Accredited
More informationAppendix 3A. MA Companion Guide: CMS Supplemental Instructions for EDR and CRR Data Elements
Appendix 3A. MA Companion Guide: CMS Supplemental Instructions for EDR and CRR Data s A3A.1 LOOPS AND SEGMENTS APPLIED TO EDR AND CRR SUBMISSIONS... 3 A3A.2 CONTROL SEGMENTS: CMS SUPPLEMENTAL INSTRUCTIONS
More information12. IEHP I INSTITUTIONAL CLAIM COMPANION GUIDE A. Included ASC X12 Implementation Guides
1. 005010X223A2 Health Care Claim: Institutional Standard Companion Guide (CG) Transaction Information Effective January 1, 2018 IEHP Instructions related to Implementation Guides (IG) based and on X12
More informationCopyright Red Raven Productions. Designation X12 Founded in 1979 August of 2000 Transaction Standards
PRESENTATION HIPAA Privacy & Security X12 ICD GEM It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. - Charles Darwin HIPAA X12N - ICD
More informationHIPAA Transactions: Requirements, Opportunities and Operational Challenges HIPAA SUMMIT WEST
HIPAA Transactions: Requirements, Opportunities and Operational Challenges -------------------------------------- HIPAA SUMMIT WEST June 21, 2001 Tom Hanks Co-Chair Privacy Policy Advisory Group Co-Chair
More information10/2010 Health Care Claim: Professional - 837
837 Health Care Claim: Professional HIPAA/V4010X098A1/837: 837 Health Care Claim: Professional Version: 1.8 Update 10/20/10 (Latest Changes in RED font) Author: Publication: EDI Department LA Medicaid
More information