| 1160 | 7/22/2011 | There is a need to data mine claims data for a variety of purposes. One of those purposes is to determine what providers are charging for services (the retail charge). This information is often required under state law to be presented to healthcare |
| 1158 | 7/6/2011 | The NUBC UB-04 Manual maps Form Locator 46, Service Units, to SV205, Service Unit Count, in the 5010 837I TR3. The UB-04 Manual specifies in Form Locator 46 that "A zero or negative value is not allowed.", but the note for SV205 does not contain thi |
| 1157 | 5/13/2011 | Errors noticed in the 005010X223A2 document:
1. Loop 2300 "Claim Information" - Position 1300 - CLM "Claim Information" segment:
"TR3 Example: CLM*12345656*500***11:A:1*Y*A*Y*I~"
Note that CLM06 is now NOT USED. But the TR3 example has a "Y" in |
| 1148 | 2/15/2011 | Many Medicaid Managed Care Organizations receive payments that exceed the allowed number of digits in the Imp Guide. Work arounds are performed today but these work arounds might be construed as being out of HIPAA compliance. |
| 1147 | 2/4/2011 | Some Medicaid payers always report their payments as a tertiary status even though the claim was submitted how the claim was actualy submitted. |
| 1146 | 2/4/2011 | Have Claim Level Payment amouts equal the total of payments reported at the service level to aid in the processing of and the balancing of remittance transactions. United Healthcare now reports the total they are remitting at the claim level, but pa |
| 1145 | 2/4/2011 | There are state and federal reporting requirements where the claim encounter transaction should contain payment information. |
| 1144 | 2/4/2011 | There is a need for a provider to receive plan administrator information, designated by the sponsor, in a 271 Health Care Eligibility Benefit Response. |
| 1143 | 2/4/2011 | More efficient processing of 835 files |
| 1142 | 2/4/2011 | More efficient processing of 835 files |
| 1141 | 2/4/2011 | The patient reason for visit for all outpatient claims is not valid for many outpatient claims where a service is performed while the patient is not visiting the institution, e.g. outside lab work.
The UB04 guide has the list of criteria for valid |
| 1140 | 2/4/2011 | To allow for the accurate and appropriate identification of plan enrollees when "Patient’s Member ID (or the HIPAA Unique Patient Identifier once mandated
for use)idenfitication" is not available. |
| 1139 | 2/3/2011 | New Codes and/or New Data Elements Needed to Minimize Use of the MSG Segment in the 271 Transaction |
| 1137 | 2/3/2011 | simplification and reduced cost |
| 1133 | 1/28/2011 | Establish consistent responses in the industry where benefits are administered by Third Parties. |
| 1131 | 1/28/2011 | The requirement to return all plan information prevents streamlining the response. This can also prevent a timely response (under 60 seconds) in a real-time situation. Some payers carry benefit information in separate systems. For example, dental |
| 1130 | 1/28/2011 | Payers need to know the dates that a patient received different levels of care for claims that include multiple inpatient room and board (R&B) revenue codes that distinguish the levels of care. Examples of revenue codes that have different levels of |
| 1129 | 1/27/2011 | Different payer edits can apply to different teeth. The providers need to know the tooth number used to adjudicate the claim line. It could differ from what the provider was expecting. There is no other way in the 835 to communicate this informati |
| 1128 | 1/27/2011 | Clearly and explicitly report the adjudicated patient name when it is different from the submitted patient name. |
| 1127 | 1/27/2011 | Clearly and explicitly report the adjudicated patient name when it is different from the submitted patient name. |
| 1126 | 1/27/2011 | February 4, 2011 deadline to submit revision requests related to the ASC X12 005010 Type 3 Technical Reports (TR3), to be considered for inclusion in 006020.
Consistency Needed Across Transactions. |
| 1125 | 1/27/2011 | Allow the provider to tie the forward balance (and subsequent recovery) to the specific claim rather than the payment ID. |
| 1123 | 1/27/2011 | In order to establish uniformity in billing practices among provider where a dependent has a unique Member ID but is not technically the subscriber. |
| 1122 | 1/27/2011 | Provider Taxonomy in Pay-To Provider is used for provider matching process. Some providers bill under multiple specialties. |
| 1121 | 1/27/2011 | In order to establish uniformity in billing practices among provider where a dependent has a unique Member ID but is not technically the subscriber. |
| 1120 | 1/27/2011 | Provider Taxonomy in Pay-To Provider is used for provider matching process. Some providers bill under multiple specialties. |
| 1119 | 1/27/2011 | In order to establish uniformity in billing practices among provider where a dependent has a unique Member ID but is not technically the subscriber. |
| 1118 | 1/27/2011 | Provider Taxonomy in Pay-To Provider is used for provider matching process. Some providers bill under multiple specialties. |
| 1112 | 12/8/2010 | Outdated information regarding Certificate of Medical Necessity forms (CMNs) exists in the 837P 5010 Loops 2000B and 2000C in the PAT07 and PAT08. |
| 1110 | 12/3/2010 | PER Margaret's request.....HELP YOU HELP ME..
Please create and maintain a Group code CARC code and RARC code matching grid (See MN companion guide http://www.health.state.mn.us/asa/mn835guide092909.pdf) |
| 1109 | 11/10/2010 | To provide consistency across transactions for implementers of all transactions. |
| 1106 | 9/29/2010 | The Federal Substance Abuse Rules (FSAR) impose restrictions on the use and disclosure of alcohol and drug abuse patient records that are maintained in connection with the performance of any federally assisted alcohol and drug abuse program. FSAR pro |
| 1105 | 8/31/2010 | To transition from paper to electronic health care transactions and eliminate the numerous phone calls, faxes and e-mails that plague the current system, patients, physicians and other health care providers need to receive all the information necess |
| 1094 | 2/18/2010 | We have a high cost estimate for implementing data element N407 (Country Subdivision Code) in the HIPAA 5010Version and would like to understand the rationale and original intent for adding this data element. Please provide the purpose and who will |
| 1093 | 12/29/2009 | Modifications to the HIPAA implementation guides for electronic health care transactions are needed to allow for the identification of the Universal Product Number (UPN) for medical and surgical supplies.
Recent state and federal initiatives1 rela |
| 1088 | 10/29/2009 | Currently, TR3 written with Summary PLB03-1 listing values/qualifiers - includes 'IR' for IRS/federal withholding.
No qualifier is available to support STATE withholding. Request qualifier for state withholding to accurately report to provider |
| 1087 | 10/23/2009 | new EB03 codes for screening and diagnostic colonoscopies |
| 1085 | 8/31/2009 | ASC X12 N is requesting the DSMO to consider recommending to NCVHS that the following ASC X12 acknowledgement transactions be considered for adoption as HIPAA required transactions by HHS/CMS/OESS, using version 005010.
• ASC X12 999 Acknowledgeme |
| 1080 | 6/3/2009 | In a large provider organization with multiple practice/administration/billing sites, it is often difficult to process refund request letters from the payers in time. A number of times, the letter is received and processed but the payer either does n |
| 1078 | 5/18/2009 | It would be more efficient if each code source listing in the Code Sources Appendix of each Implementation Guide / Type 3 Technical Report always included an Internet Universal Resource Locater (url), plus any needed navigation instructions, for impl |
| 1077 | 3/19/2009 | Newborns which do not have insurance id number and must use mother's id number |
| 1076 | 3/4/2009 | The 835 needs to change CLP06 to allow reporting of payment of HSAs. It needs a new code. |
| 1075 | 1/15/2009 | This issue concerns the 5010 837 Professional TR3. CMS requested changes be made to the next version of the 837P IG regarding Loop 2320 SBR05. Specifically, CMS requested that the values in 2320 SBR05 match the values in the 2000B SBR05 with multiple |
| 1074 | 12/31/2008 | ASC X12 N is requesting the DSMO to consider recommending to NCVHS that the following ASC X12 acknowledgement transactions be considered for adoption as HIPAA required transactions by HHS/CMS/OESS, using version 5010.
ASC X12 999 Acknowledgement t |
| 1073 | 11/21/2008 | HIEC codes were merged into HCPCS starting in 2002. See http://www.nhianet.org/resource/hiec/nationalperdiem.cfm for starters. |
| 1071 | 9/28/2008 | We need a compliant way of adjudicating claims for transplant living donor claims.
From a provider perspective they would submit the 837 claim correctly reflecting the donor as the patient (Loop 2000C, PAT01=39).
However, there is no corres |
| 1070 | 7/21/2008 | Update - to clarify:
In support of the X12 work on "005010X214 - 277 Health Care Claim Acknowledgement" and the work that WEDI has accomplished regarding the acknowledgements white-paper - I recommend that via the DSMO process, the "005010X214 - |
| 1069 | 4/15/2008 | The Final Rule for Standards for Electronic Transactions released on August 17, 2000 discusses the standard data content for adopted standards which will facilitate consistent and identical implementation. Although this includes data dictionaries, i |
| 1068 | 3/25/2008 | Several dental providers (oral and maxillofacial surgeons, periodontists, and others) routinely submit claims to medical plans using the 837 Professional Claim. These providers frequently need to designate the tooth number(s) and/or oral cavity area |
| 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 |