Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 927 Date: July 29, 2011

Transcription

1 anual ystem Pub One-Time Notification Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 927 Date: July 29, 2011 hange equest 7484 UBJET: Populating E egment - Other laim elated djustment - for ealthcare laim Payment/dvice or Transaction 835 Version UY O NGE: This hange equest () instructs V and to populate E egment - Other laim elated djustment - for ealthcare laim Payment/dvice or Transaction 835 version under specific situations (e.g., for cost avoid claims) using one of the qualifiers included in the attached updated lat ile. EETVE DTE: January 1, 2012 PLEENTTON DTE: January 3, 2012 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED- /N/D PTE / ETON / UBETON / TTLE N/. UNDNG: or iscal ntermediaries (s), egional ome ealth ntermediaries (s) and/or arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

2 V. TTENT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

3 ttachment One-Time Notification Pub Transmittal: 927 Date: July 29, 2011 hange equest: 7484 UBJET: Populating E egment - Other laim elated djustment - for ealthcare laim Payment/dvice or Transaction 835 Version Effective Date: January 1, 2012 mplementation Date: January 3, GENEL NOTON. Background: urrently the E segment - Other laim elated djustment at Loop 2100 is not being populated on the Part B side, and the 835 lat ile identifies that with a note: N/U by Part B. fter some discussion, the enters for edicare and edicaid ervices () has decided that valuable information can be sent using this segment that would help providers/suppliers. This hange equest () instructs V and to populate this segment under specific situations (e.g., for cost avoid claims) using one of the qualifiers included in the attached updated lat ile. This also updates the 835 flat file by adding: - PLB ode 90 (refer to 7287) - Qualifier PQ to be used in Loop 1000B E Payee dditional nformation under some special situations where the NP is not available. B. Policy: The dministrative implification provisions of P egulations require the ecretary of to adopt standard electronic transactions and code sets for administrative health care transactions. The ecretary may also modify these standards periodically. enters for edicare and edicaid ervices () will implement the new P standard (X12N version 50101) and any modifications and be ready for testing by January 1, 2011 and for production by pril 1, BUNE EQUEENT TBLE Use hall" to denote a mandatory requirement Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers and V shall populate E egment (Other laim elated dentification) at Loop 2100 under some E V W

4 Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers special situations (e.g.; ost voided laims) and V shall use one of the following eference dentification Qualifiers in E01 as appropriate: 28: Employee dentification Number 6P: Group Number E: edical ecord dentification Number 8: Original eference Note: ee attached updated 835 lat ile E V W and V shall also populate N1 orrected Priority Payer Name segment at Loop 2100 when using 6P qualifier in E01 per and V shall populate E02 with the Other nsured Group Number for the payer identified in N1 orrected Priority Payer Name segment when using 6P qualifier in E01 per and V shall use laim tatus ode 2 in LP02 in LP laim Payment nformation segment at Loop 2100 when the claim is processed as an P claim (e.g., ost voided laims) V shall update edicare emit Easy Print (EP) software to include this additional E segment in the EP emittance dvice for version ontractors shall be ready to accept the updated 835 lat ile from and V. X ED. POVDE EDUTON TBLE

5 Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. E V W X ED V. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements, use the box below: N/ Use "hould" to denote a recommendation. X-ef equirement Number ecommendations or other supporting information: ection B: or all other recommendations and supporting information, use this space: N/ V. ONTT Pre-mplementation ontact(s): umita en at umita.en@cms.hhs.gov or Post-mplementation ontact(s): ontact your ontracting Officer s Technical epresentative (OT) or ontractor anager, as applicable.

6 V. UNDNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s), and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. or alternate format, please contact the author. ttachment: 835 lat ile

7 835 lat ile hange Log Date Loop Data Element hange eason for hange hanged in epetition 6/9/ hange Description 2. No Value eparator is a delimeter and not a data element 6/9/08 - G08 One line instead of two 6/9/08 - PLB03-2 PLB05-2 PLB07-2 PLB09-2 PLB11-2 PLB13-2 dd Treasury Telephone # Providers are to call the Treasury directly if there is any Treasury withholding for ederal Debt 6/30/ T301 in-ax changed to from Per G ax is 50 8/5/ O03-O07 in-ax changed to from Per G ax is 50 9/17/ O03-O07 and Pic lause X(5) added To reflect edicare decision 10/28/ To reflect current version 10/28/ /2110 ll E02 fields are same length 50 onsistency 10/28/ /2110 ll PE 04/06/08 are same length 256 onsistency 10/28/08 LX01 values added to cover dded 1 and 0 orrection per 10/28/ LP 06 "B" added as a possible value To cover Part B 10/28/ LP 08 The description changed To cover Part B 1/23/ from ield length is only 5 1/23/2009 BP05-BP16 Values in the "tart" column changed To reflect the field lengths correctly 1/23/ PE - Payer Web ite 1/23/ LP07 1/23/ LP08-LP13 1/23/2009 PLB12-PLB14 2/9/ PE - Payer Web ite/pe01 7/21/ npatient djudication nformation 4/13/2010 T03 4/13/2010 TN04 5/7/2010 TN04 7/27/ T216 7/27/2010 PLB 7/27/2010 PLB03-1/PLB05-1/PLB07-1/PLB09-1/PLB11-1/PLB13-1 Values added under field length column for PE02, PE05, PE06, PE07, and PE08 although they are not used ield length changed To be consistent with other PE segments within 835 to 50 from 30 ax is 50 in 5010 Values in the "tart" s a result of changing the field column changed length for LP05 to 50 Values in the "tart" column changed To reflect the field lengths correctly Value changed from To reflect the value correctly per 1 to T3 Length changed from 18 and 15 to 15 and 18 for 01 and 02 respectively. To follow the max length in the T3 dded T03 - a Not To be consistent with other Used field segments within 835 Length changed from T3 has expanded this field size to 30 to The length updated to 50 OBOL P clause - 9(3)V9999- added t was missing Qualifier TL added - for TE recoupment per O TL - assigned for TE related request adjustment Note for amount field changed To be consistent with other flat files 1

8 835 lat ile hange Log 7/27/2010 9/14/2010 G08 3/7/ /21/ /2/ /07/10/13/16 /19 04/07/10/13/16 /19 E - Other laim elated dentification separate column for OBOL P added Value changed from X221 to X2211 OBOL P UPDTED TO 9(7)V999 OBOL P UPDTED TO 9(7)V999 The note (N/U by Part B) has been removed To be consistent with other flat files To address ET To accommodate fractional units To be consistent with segment at the line level /s/ agreed that valuable information can be sent in thiis segment to help providers 6/24/ B E - Payee dditional nformation dded qualifier "PQ" f NP is not available, need to use the PTN or the O # under some special situations. 6/24/2011 PLB PLB03-1/PLB05-1/PLB07-1/PLB09-1/PLB11-1/PLB13-1 Qualifier "90" added ee