| 1067 | 10/31/2007 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Eligibility Work Group (WG1) are submitting the following Technical Report Type 3 (TR3) as a version upgrade and replacement for the 270/271 HIPAA Health Care Eligibility Benefi |
| 1066 | 10/31/2007 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Claims and Encounter Work Group (WG2) are submitting the following 005010X224A1 Errata Document to compliment the 005010X224 Technical Report Type 3 (TR3) for the 83 |
| 1065 | 10/31/2007 | The X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Claim and Encounter Work Group (WG2) are submitting the following 005010X223A1 Errata Document to compliment the 005010X223 Technical Report Type 3 (TR3) for the |
| 1064 | 10/31/2007 | The X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Services Work Group (WG10) are submitting the following 005010X217E1 Errata Document to compliment the 005010X217 Technical Report Type 3 (TR3) for the 278 Healt |
| 1063 | 10/6/2007 | The NCPDP membership is requesting a new standard be named in HIPAA for use in the pharmacy industry – the Post Adjudication Standard Implementation Guide, version 2.Ø. The Post Adjudication Standard Implementation Guide version 2.Ø supports the repo |
| 1060 | 3/30/2007 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Premium Payments Work Group (WG4) are submitting the following Technical Report Type 3 (TR3) as a version upgrade and replacement for the 820 HIPAA Premium Payment Transaction ( |
| 1059 | 2/12/2007 | Referring number not needed to process claims. |
| 1057 | 12/7/2006 | The NCPDP membership is requesting a new standard be named in HIPAA for use in the pharmacy industry – the Medicaid Subrogation Standard Implementation Guide, version 3.Ø. Medicaid Subrogation is a process whereby Medicaid is the payer of last res |
| 1055 | 12/7/2006 | The NCPDP membership is requesting a new version of the Telecommunication and Batch Standard be named in HIPAA. The Telecommunication Standard Implementation Guide is version DØ. The Batch Standard Implementation Guide is version 1.2, which supports |
| 1054 | 10/27/2006 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Enrollments Work Group (WG4) are submitting the following Technical Report Type 3 (TR3) as a version upgrade / replacement for the 834 HIPAA Transaction, which is currently adop |
| 1053 | 10/3/2006 | Would like to request a modification to the format of the PLB segment. PLB for providers are a very manual and tedious process. The use of clearing accounts to post PLB values to cause problems and are not recommended by our accounting and auditin |
| 1052 | 9/30/2006 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Services Work Group (WG10) are submitting the folloing Technical Report Type 3 (TR3) as a version upgrade / replacement for the 278 HIPAA transaction, which is curre |
| 1051 | 9/30/2006 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Claims Status Work Group (WG5) are submitting the following Technical Report Type 3 (TR3) as a version upgrade / replacement for the 276/277 HIPAA transactions, whic |
| 1050 | 9/15/2006 | X12 Code Sources 22 and 51 refer to United States Postal Service Publication 65, "National 5-Digit ZIP Code and Post Office Directory". According to the notice at http://www.usps.com/ncsc/addressinfo/zipcodedirectories.htm , "Printed copies of the P |
| 1046 | 9/13/2006 | Some clients in the social services system do not have a first name such as native Americans with names such as 'little bear' 'quiet horse', etc., and prefer to be addressed as such. The Connecticut Social Services System allows a first name to be b |
| 1045 | 7/29/2006 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2), and the Health Care Claims and Encounter Work Group (WG2) are submitting the following Technical Report Type 3 (TR3) as a version upgrade / replacement for the 837 HIPAA transaction, w |
| 1044 | 7/29/2006 | X12 Insurance Subcommitte (N), the Health Care Task Group (TG2) and the Health Care Claim and Encounter Work Group (WG2) are submitting the following Technical Report Type 3 as a version upgrade / replacement for the 837 HIPAA transaction, which is c |
| 1043 | 7/29/2006 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Claim and Encounter Work Group (WG2) are submitting the following technical Report Type 3 (TR3) as a version upgrade / replacement for the 837 HIPAA transaction, whi |
| 1042 | 7/29/2006 | X12 Insurance Subcommittee (N), the Health Care Task Group (TG2), and the Claim Payment Work Group (WG3) are submitting the following Technical Report Type 3 (TR3) as a version upgrade/replacement for the 835 HIPAA transaction, which is currently ado |
| 1039 | 2/27/2006 | Request pertains to the 837 and 835 Transactions. Per HIRs 277 and 344, the 835 transaction does not allow a zero dollar amount in the CAS segment however there is no such rule/interpretation of the same requirement in the 837 transaction. Currentl |
| 1034 | 12/18/2005 | As proposed for use in Claims Attachments transactions, LOINC values for identifying attachments are more expressive than report type codes currently used in PWK01. LOINC should be evaluated as a replacement or supplement for the codes presently use |
| 1031 | 11/30/2005 | [The following is a wild and crazy idea to improve the clinical effectiveness of a health care encounter.] In addition to the 'usual' information returned in response to a health care eligibility request, also return a list of all medications dispe |
| 1028 | 9/2/2005 | An 4010X098A1 (claim) file gets created with a billing loop that looks like: NM1*85*2*Name here*****24*111111111~ N3*address1*address2~ N4*city*st*zip~ REF*G2*2222222~ The claim goes through fine. I send over a 4010X093A1 (status) request fo |
| 1027 | 7/22/2005 | Payer entering arrangement with Financial custodian for HDHP (HSA). Financial custodian will issue credit card. Member will use credit card at point of service. Agreement is for payer to send claims liability and cost share data to the Financial cust |
| 1025 | 6/15/2005 | TPA's are legally liable for reporting changes in eligibility to payers even when that change occurs in a prior period of coverage, but there is no facility in 834 to specify a change to a prior period of coverage without terminating coverage. The Lo |
| 1023 | 2/3/2005 | The COBRA Qualifying Event Code (INS07) in the 834 IG does not provide codes for voluntary termination or retirement, which are required qualifying events under COBRA Law. |
| 1017 | 12/17/2004 | Implementation Specification as written can not be used with National Provider Identifier (NPI). Page 73 [unmodified by Addenda] of 004010X061 specifies a value of "65" in ENT03 to indicate the National Employer Identifier is contained in ENT04. A v |
| 1016 | 12/16/2004 | It is not possible to report tooth numbers in the 837 professional transaction for MEDICAL claims. This is principally a wisdom tooth issue but also relates to traumatic dental injuries that fall under the coverage umbrella of a medical carrier. Th |
| 1015 | 10/26/2004 | The way the imp guide is written - there's no way for the payer to say "no middle initial" and not violate an X12 rule. Bottomline to me as a provider - every time a payer does this - my 835 FAILS in validation... and has to be manually handled. |
| 1013 | 10/13/2004 | Pre-existing condition applies to all new members and dependents enrolled in the Oklahoma State and Education Employees Group Insruance Board health plan. There are instances when Pre-EX needs to be waived but there is no indicator in the 834 for wai |
| 1012 | 10/6/2004 | The Oklahoma Legislature mandates the Oklahoma State & Education Employees Group Insurance Board (OSEEGIB) to offer various levels of life coverage. In addition to communicating the coverage levels in the 834, OSEEGIB must also be able to communicate |
| 1011 | 10/6/2004 | The Oklahoma Legislature mandates the Oklahoma State and Education Employees Group Insurance Board (OSEEGIB) to offer various levels of life coverage. OSEEGIB must be able to include life coverage and the different levels in the 834. |
| 1008 | 8/30/2004 | The later version of 835 Implementation Guide contains additional valuable information that will benefit the industry for those attempting to use the 835. The Claim Payment workgroup and the Health Care Task Group of ASC X12 Insurance Sub Committe |
| 1005 | 7/8/2004 | The request is to remove codes 02 and 03 from the CRC03 at both the 2300 and 2400 loops. In version 4050, code 12 was added to this data element. Code 12 states - "Patient is confined to a bed or chair. Use code 12 to indicate the patient was bedridd |
| 1002 | 6/9/2004 | The current 837 Professional claim does not have a field for the time of pickup for transportation providers. This information is used to determine whether a claim is a duplicate to another claim. Without this information, claims for transportation |
| 1001 | 5/19/2004 | Need a way to designate a person (subscriber or dependents) as a late enrollee. Many plans are offering a different set of benefits or waiting periods for late enrollee's. This would be a Maintainance Reason Code. |
| 1000 | 5/6/2004 | Sending U&C data (per CPT Code) between trading partners. |
| 872 | 4/20/2004 | The implementation guide specifications for the 271 do not currently allow return of the subscriber date of birth (DOB) if the subscriber is not the patient. Specifically, the DMG segment includes notes as follows: 1. “Use this segment to conv |
| 869 | 4/7/2004 | We would like to store Note type information in the claims detail level to communicate how a particular claim was repriced. The current codes for claims processing are too generic and we are requested by our clients to populate more information. Th |
| 867 | 4/5/2004 | Dear Sirs: We have come across an interpretation ‘difference’ between vendors in the 837PA1 Loop 1000A PER segment, element PER02. The V4010X098 IG (page 72) depicts this element as REQUIRED but with the following note: (start IG) REQUIRED |
| 866 | 3/16/2004 | The International Standard Designation System for Teeth and Area of the Oral Cavity has been included in the TOO segment of the 837D Version 5010. We suggest it is a better fit in the SV304 of the Dental Service Segment-Oral Cavity Designation Cod |
| 864 | 3/2/2004 | As a result of legslation in California and other states, we need to provide the Payer's web site URL in the 835 in order to identify exactly where providers can go to get information like appeal policies, complaint policies, medical policies and any |
| 863 | 3/1/2004 | This information was, in the past, specifically used by Medicare Part B for processing ambulance claims. Medicare is no longer using this information and we (American Ambulance Association and CMS) are requesting that it be removed from the Professio |
| 861 | 2/28/2004 | I would like to suggest that the United States PHI's NOT be allowed to go to off shore companies for processing. The business case is the Berkel;y case where a Pakistani woman tried to blackmail U of Berkely and dthreatend to post PHI records on the |
| 860 | 2/26/2004 | Change request #576 for including ICD-9 diagnosis codes in the dental claim for certain procedures was disapproved by the DSMO steering committee with the following language. The DSMO recommends the submitter should pursue this action through th |
| 859 | 2/26/2004 | Change request #159 for procedure code modifiers in the electronic dental claim was approved by the DSMO steering committee with the following language. Leave as situational but replace the second note "Used at the discretion of the submitter." wi |
| 858 | 2/26/2004 | Some states require reimbursement of taxes associated with services provided. Change request #239 added a tax amount, but the semantic note to CLM02 was not changed to reflect this additional data element. Consequently, the tax amount is not in |
| 857 | 2/12/2004 | In the IG of the Institutional, there are two NTE segments with repeats of 10 each in the 2300 loop (claim level). There is no NTE segment listed for the 2400 loop (service line). On page 205 of the IG, the first NTE segment in the 2300 loop (for |
| 854 | 1/5/2004 | There are instances where in a large number of claims may need to be adjusted due to an error in payment. In these instances, the plan may opt to settle with the provider for a set dollar amount for claims prior to a certain date. In these instance |
| 853 | 12/10/2003 | The 837D 004010X097A1 implementation guide currently does not allow for the use of HCP segment for dental claim pricing/repricing information. Our business needs require HCP segment for dental PPO claims to report discounts. Since HCP is availabl |
| 850 | 11/11/2003 | 4010X098(A1), in loop 2300, segment CRC, qualfier 07, elements 2 and 3, pages 257, 258 in the guidelines. Element 3 is the condition code related to ambulance services. Element 2 is whether the condition codes apply. The whole segment is required |
| 847 | 10/31/2003 | The Physician Tax I.D. number is not a known element at the hospital level. Additionally, when we contact the physicians they are often not willing to provide this information. |
| 846 | 10/24/2003 | HIPAA requires that claims involving pregnancy include the date of the last menstrual period (LMP). This information is not reliably available in 10% to 45% of pregnancies (Obstetrics & Gynecolog, June 2000, Volume 95, Number 6, Part 1, Pages 867 - |
| 845 | 10/17/2003 | ANSI 837 guide mandates that Home Health Claims contain the most recent inpatient stay dates in CR6-16 (Loop 2300); but this data is not applicable or available for many claims. |
| 844 | 9/30/2003 | Loop 2305 - Position 243, Health Care Services Delivery: Inadequate choices under HSD05 (Duration of Visits Units) is leading to a discrepancy between the Claim submission data and the Plan of Care. |
| 843 | 9/25/2003 | The insured date of birth as a required field should be situational. This information is not always known by the patient, especially during emergency situations. There is no easy mechanism to obtain this information (for example - on the insurance ca |
| 842 | 9/24/2003 | Allow Originator of 837 Claim file to identify conditions/components used to produce claim file. |
| 841 | 9/12/2003 | Addenda 004010X093A1 changed the 2200D/TRN segment from situational to required. This causes a 2200D loop to be required when the inquiry is for a dependent. Usage notes state that 'Use of this segment is required if the subscriber is the patient'. |
| 840 | 9/10/2003 | Currently, Loop 2200E, REF (1K), Payer Claim Identification Number is required. If a claim cannot be found that meets the search criteria submitted in the inquiry and the inquiry did not contain a REF segment with Payer Claim Identification number, |
| 837 | 8/19/2003 | The ability to report insurance-specified identifiers for the performing hospital facility/service is a requirement of many carriers who routinely forward claims to secondary payors for Coordination of Benefit billing (COB). Prior to the HIPA |
| 836 | 8/18/2003 | On page 210 of the implementation guide, the Payer claim identification number in the dependent loop is a required segment. However, if a provider sends us search criteria other than the claim number and we do not find any matches in our system, wha |
| 835 | 8/15/2003 | Page 77 of the 837 Professional IG states "If the Billing or Pay-to-Provider is also the Rendering Provider and Loop ID-2310A is not used, the Loop ID-2000 PRV must be used to indicate which entity (Billing or Pay-to) is the Rendering Provider." |
| 833 | 8/15/2003 | With the current transmission flat file 997, The carrier transmitts immediately after receiving a transmission information which designates errors by record line, claim segment and data element. However you do not identify which data refers to which |
| 832 | 8/7/2003 | Re: the ANSI 837 Institutional Claims, Loop 2305, the HSD data segment (Health Care Services Delivery). We are a Home Health Care business and we are required to transmit this data segment to Medicare. However, I |
| 828 | 8/7/2003 | Section 2.2.1.2 in the 835 Implementation Guide (X091A1WPC.pdf Combined Guide) lists equations and supporting information for the calculation of CLP03 and CLP04 but there is no mention of how to calculate CLP05 (Patient Responsibility Amount). If |
| 823 | 7/23/2003 | The X12 835 IG provides the incorrect information for the CLP09 data element. |
| 821 | 6/26/2003 | 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 ARMRE |
| 816 | 5/30/2003 | In the ANSI ASC X12N 4010 Implementation Guide, the diagnosis code element is required on all claims/encounters except claims for which there are no diagnoses (e.g., taxi claims). The American Clinical Laboratory Association (“ACLA”) believes requir |
| 811 | 5/21/2003 | CR2 – Spinal Manipulation Service Information This segment was originally established based on Medicare chiropractic policy requirements. Current Medicare chiropractic policy requires the initial course of treatment and the date of x-ray. The l |
| 805 | 4/17/2003 | Triple-S, Inc. April 17, 2003 TRANSACTION 270/271 USE OF THE MESSAGE SEGMENT IN LOOP 2110C Business Need # 1: Triple-C is a subsidiary of Triple-S Management Corporation. This subsidiary is dedicated to the Medicaid managed care portio |
| 803 | 4/14/2003 | Ncpdp Version 5.1 and Ncpdp Batch 5.1 both require the date that the prescription was filled for billing adjudication. In the X12 835 Implementation Guide, neither Loop 2100 DTM segment (Claim Date) nor Loop 2110 DTM segment (Service Date) have a fi |
| 802 | 4/9/2003 | The claim adjustment codes specified in the 835 standard (loop 2100 at claim level and loop 2110 at service level - CAS segment) are not specific enough for payors to communicate the true rejection/denial reason to the providers. Multiple payor propr |
| 800 | 3/31/2003 | Final Privacy Rule Requires the 837 4010 Implementation Guides to Change ISSUE: HIPAA Revised Privacy Rule Impacted HIPAA Transaction Standards In HIPAA privacy rule issued in the Federal Register dated December 28, 2000, Section 164.506 requir |
| 795 | 3/26/2003 | The final addenda removed the loop containg the Referring Provider information (2310D) and consolidated this information along with the Ordering Provider, Assisting Provider, etc. into the Other Provider loop (2310C). This change did not include any |
| 791 | 3/25/2003 | I believe that the Usage on a segment/loop is incorrect. |
| 789 | 3/24/2003 | Payor's request language at the member level in order to target member service communication at the member level. this is needed to allow submission of member language for the member whether or not the member is the subscriber. |
| 788 | 3/21/2003 | Our current systems use UB92 field 22.8C (positions 107-110) for newborn birthweight for sick babies to determine DRG payment. In 4010 837I, this was in the 2000B and 2000C loops, PAT08 segment. In 4010A, loop 2000B PAT segments have been del |
| 786 | 3/19/2003 | Health Care Elegibility Request or Response March 18, 2003 Triple-S currently provide our providers the capability of requesting eligibility for certain procedures which only limitation is the maximum amount allowed under the patient's cover. |
| 784 | 3/6/2003 | In Loop 2305 HSD segment, the example is HSD*VS*2*DA*4*7*20~ means 2 Visits every 4 days for 20 days. Lets take the below valid example. HSD*VS*2*Q1*1*35*16~ means 2 Visits every Quarter for 16 weeks. Usually 16 weeks in the above case is n |
| 782 | 3/4/2003 | To be consistent throughout the 837 Professional, as well as in all IG's. I would recommend that the field TIME, be consistent. For example the ISA10 and TA103 are both HHMM, yet the GS05 and the BHT05 vary anywhere from 4 to 8 bytes, which makes thi |
| 781 | 2/27/2003 | ANSI specifications for ambulance claims. |
| 779 | 2/24/2003 | 837 Professional: Medicare carriers process claims in areas that may have different payment localities. They process claims within their jurisdiction based on the zip code of where the service was rendered. Currently, if the service was rende |
| 771 | 2/21/2003 | 834 Enrollment “Race or Ethnicity Code” DMG05, (4010A1) There needs to be a national directive for consistency. If a person is White, which code would you choose? C – Caucasian O – White (Non-Hispanic) H – Hispanic If a person is Black and |
| 769 | 2/21/2003 | Business Reason Clarification on the proper structure of HL levels for all the transactions that contain HL's would be beneficial. For example, the 270/271 IG appears to state that an appropriate HL structure occurs where the inquiry detail must ei |
| 767 | 2/13/2003 | The service type codes listed for EB03 (loop 2110C on page 221 of 270/271 IG) do not cover situations where benefits are exclusive e.g. Inpatient hospital ONLY or Emergency coverage ONLY etc. As such, these would have to be deduced by absense of othe |
| 766 | 1/29/2003 | With respect to the HIPAA 835 (ERA), the Division of Benefit Coordination at the Centers for Medicare & Medicaid Services has the following request: Currently, the 835 (ERA) only allows for printing of the identity of only one (1) supplemental pay |
| 764 | 1/29/2003 | The Centers for Medicare and Medicaid Services (CMS) Change Request (CR) 2007 identifies a loop and segment for physicians and suppliers to put the Obligated to Accept as Payment in Full Amount (OTAF) for Medicare Secondary Payer (MSP) claims. The M |
| 763 | 1/20/2003 | With new Medicare DMERC ABN used for bene requested upgrade requirements, there are a number of situations where more than 4 modifiers are required to be submitted with a HCPCS. Currently DMERC's require additional modifers be submitted in the NTE se |
| 761 | 1/10/2003 | To make the i.g. more readable, less confusing and easier to implement. |
| 760 | 1/9/2003 | Users are confused about the use of dashes in the EIN and the SSN. |
| 759 | 1/8/2003 | Currently, the ICD-10-Clinical Modifications (ICD-10-CM) and the ICD-10-Procedure Coding System (ICD-10-PCS) is under development by the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) respectivel |
| 757 | 1/6/2003 | In the 4050 Professional and Institututional Draft Implementation Guides (and would assume the Dental as well) A.1.2.7 when defining Delimiters states that the ISA Segment is a fixed length record, "The ISA seg-ment is a 105 byte fixed length record, |
| 754 | 1/2/2003 | In the HIPAA 834 IG the INS segment has a maximum allowed occurrance of 10,000 in one ST. Our monthly 834 compare file exceeds 10,000 members. We would like to see the maximum removed so that the HIPAA 834 IG reflects the 834 Standard. This would all |
| 751 | 12/26/2002 | Generation of a compliant 835. |
| 747 | 12/5/2002 | The Pennsylvania Department of Public Welfare (DPW) respectfully requests approval of five additional loops to loop 2320 (making it a total of 10 loops) of the 834 HIPAA Benefit Enrollment and Maintenance transaction to eliminate the need to send an |
| 745 | 12/4/2002 | Triple-S, currently offer our providers the capability of requesting claims status in two different ways: all claims within a range of dates of service or by contract number. The 276 transaction has the required structure and data elements to reque |
| 744 | 11/29/2002 | Consistency in responding to inappropriate coding in 270s |
| 742 | 11/15/2002 | Currently there is not a specific claim filing indicator code on the CLP06 of the 835 transaction that accurately describes Medicare supplemental Insurance. See page 92 OF THE ASC X12N 835 ( 004010X091 ) |
| 739 | 10/21/2002 | The Implementation Guides for all HIPAA transactions show the N403 element - Postal Code of the N4 segment as Required, but not all international addresses have Postal Codes. |
| 738 | 10/11/2002 | Add two values to Data Element SVC01-1 (N6) National Health related Item code in 4-6 format, and (UI) UPC Consumer package code in 1-5-5 format. |