Change Request Detail
No.
821
Date
6/26/2003
Submitter
Type of Request
Professional Claim (HCFA 1500)
Status
DSMO Process Completed
Business Reason
The HA0 record is being replaced with the NTE segment.  Currently the HA0 record supports 280 characters. (example here)
CORRECTED CLAIM  PATIENT OWNS EQUIPMENT PRIDE JET3 SERIAL NUMBER J1707301014100B  DOP 4 4 01LABOR WAS FOR REPLACING BROKEN ARMRESTS WITH NEW ONES.  MFG SUGGESTED PRICE FOR 3 UNITS OF TIME IS: $33.87.  REPLACED ARMRESTS PART NUMBER SETLRAM1097 AND SETLRAM1098.  THE ARMRESTS ARE MED

All of the above information is REQUIRED. 

The new record to replace the HA0 is the NTE, which is being limited to 80 characters.  Although the x12 standard allows for a 20x LOOP, the DMERCS have decided to limit the loop to 1x... Not only is this not enough room, it limits a perfectly good looping record.  I am requesting that they expand the loop to allow what the X12 guidelines already specify.
Suggestion
See original
DSMO Category
D
Recommendation
Disapprove. The DSMO discourages the use of free-form text in the electronic health care claim.  These types of additional supporting documentation should be sent as an attachment instead of in the claim itself. In fact, a DME attachment is under development at this time.  Currently, the PWK segment should be used to indicate that a paper attachment will be sent. Furthermore, the NTE segment cannot be required by a health plan. Rather the NTE segment may be submitted by the provider when "in the opinion of the provider, the information is needed to substantiate the medical treatment and is not supported elsewhere within the claim dataset." 
Appeal Recommendation