Transmittal 2049 Date: September 17, 2010

Transcription

1 anual ystem Pub edicare laims Processing Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 2049 Date: eptember 17, 2010 hange equest 7158 UBJET: laim tatus ategory and laim tatus odes Update. UY O NGE: The laim tatus odes and laim tatus ategory odes for use by edicare contractors with the ealth laim tatus equest and esponse X12N 276/277, ealth are laim cknowledgement X12N 277 were updated during the October 2010 meeting of that aintenance ommittee. t that time, The ommittee also decided to allow the industry 6 months for implementation of newly added or changed codes. ontractors are to use codes posted at on or about November 1, 2010, which are listed as current codes on that site. This ecurring Update Notification (UN) can be found in chapter 31, section EETVE DTE: January 1, 2011 PLEENTTON DTE: January 3, 2011 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 ; contractor activities are to be carried out within their operating budgets.

2 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 contracting 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 contracting officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTENT: ecurring Update Notification *Unless otherwise specified, the effective date is the date of service.

3 ttachment ecurring Update Notification Pub Transmittal: 2049 Date: eptember 17, 2010 hange equest: 7158 UBJET: laim tatus ategory and laim tatus ode Update Effective Date: January 1, 2011 mplementation Date: January 3, GENEL NOTON. Background: The ealth nsurance Portability and ccountability ct (P) requires all health care benefit payers to use only laim tatus ategory odes and laim tatus odes approved by the national ode aintenance ommittee in the X12 276/277 ealth are laim tatus equest and esponse format adopted as the standard for national use (004010X0931, X212) along with the 277 ealth are laim cknowledgement format adopted as the standard for contractor use (005010X214). These codes explain the status of submitted claim(s). Proprietary codes may not be used in the X12 276/277 to report claim status. The national ode aintenance ommittee meets at the beginning of each X12 trimester meeting (ebruary, June, and October) and makes decisions about additions, modifications, and retirement of existing codes. The codes sets are available at This page has previously been referenced by the following UL address: ncluded in the code lists are specific details, including the date when a code was added, changed, or deleted. ll code changes approved during the October 2010 committee meeting were posted on that site on or about November 1, ontractors must have completed entry of all applicable code text changes and new codes, and terminated use of deactivated codes by the implementation date of this hange equest (). will issue ecurring Update Notifications (UNs) regarding the need for future updates to these codes. When instructed, edicare contractors must update their claims systems to assure that the current version of these codes is used in their claim status responses. ontractor and shared system changes will be made as necessary as part of a routine release to reflect applicable changes such as retirement of previously used codes or newly created codes. These code changes are to be used in editing of all X transactions processed on or after the date of implementation and to be reflected in the X transactions issued on and after the date of implementation of this. B. Policy: edicare contractors must comply with the requirements contained in the version(s) X0931, X212, of the X12 276/277 mplementation Guide(s). edicare contractors must use valid laim tatus ategory odes and laim tatus odes when: 1. ending 277 responses in the laim tatus esponse to a laim tatus nquiry or 2. ending a ealth are laim cknowledgement 277 response to the submission of an X ealth are laim (nstitutional or Professional format).

4 . BUNE EQUEENT TBLE Use hall" to denote a mandatory requirement Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OT E B E aintainers ontractors and maintainers shall update claim status category and claim status codes that have been modified ontractors and maintainers shall use the new claim status category codes and claim status codes as applicable in 277 responses ontractors and maintainers shall not use claim status category codes and claim status codes that have been deactivated. E V W ED ED ED. POVDE EDUTON TBLE Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OT E 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 1 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 X X X X X V W ED

5 V. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. X-ef equirement Number N/ ecommendations or other supporting information: ection B: or all other recommendations and supporting information, use this space: None V. ONTT Pre-mplementation ontact: ichael abral, , Jason Jackson, Post-mplementation ontact: ichael abral, , Jason Jackson, V. UNDNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s), and/or arrier: 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 contracting 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 contracting officer, in writing or by , and request formal directions regarding continued performance requirements.