February 11, 2003
Coordination of Benefits - April 2003 System Changes
NOTE: This article contains information that may now be out-of-date or may have been updated with a more current article or policy. Primarily, 4010A1 will be the format required for ANSI X.12 after October 16, 2003.
- Beginning April 7, 2003, our system will allow film and digital mammography codes on the same claim or same date of service.
- Beginning April 7, 2003, our system will allow new specialties 32, 43, 65, 67, 71, 73 and 75. Claims with new specialties 32 and 73 will always be assigned due to the mandatory assignment requirement.
- Beginning April 7, 2003, X12 N 837 (4010) COB transactions will
be updated to meet specific HIPAA data requirements. As a result
of this upgrade the X12N 837 (4010) COB transactions are to be
generated with complete, HIPAA compliant data elements.
- The article "October 2002 changes for X12N 837 (4010)
Coordination of Benefits" posted on 09.27.02 provides
the information about "gap filling" data when issuing
an outbound X12N 837 (4010) COB transaction to generate files
with complete, HIPAA compliant data elements. In addition to
the information included in the above article:
- Item 2 has been changed to reflect the following:
The 4010 version of the ASC X12N 837 professional implementation guide states "If either NM108 or NM109 is present, then the other is required." For "gap filling" purposes, the following conditions are being considered - when NM108 is a "situational" or "required" data element: if NM108 contains a valid value and NM109 contains a value with a leading space or invalid characters, NM109 will be "gap filled." If the qualifier in NM108 is "34" and the value in NM109 is not a nine-digit numeric and/or begins with 7, 8, or 9, our system will replace the value in NM109 with "199999999." If the qualifier in NM108 is "24," the value in NM109 must be nine digits, and our system will gap fill any missing characters with "9's." If the qualifier in NM108 has other valid values, NM109 will be "gap filled" with "99."
- This is the "gap filling" information for the following elements:
- SVD03-2, SVD03-7, LQ02, FRM01 and FRM03 fields will be evaluated for compliance and will be "gap filled" with "UNKNOWN."
- SVD03-3, SVD03-4, SVD03-5 and SVD03-6 fields will be evaluated for compliance and will be "gap filled" with spaces (two space characters).
- The 4010 version of the ASC X12N 837 professional implementation guide states that the admission date is required for all inpatient medical visits claims/encounters. Since this data is not currently captured by our system for paper and non-4010 claims, our system will issue the "admission" date for the 837 (4010) COB transaction when the inbound claim is non-4010 using the earliest date of service at loop 2400, DTP03 (DTP01 = 472), for all inpatient medical visit claims. Our system will not issue the admission date for other inpatient claims, such as surgery, anesthesia, and consultations.
- Our system will not have changes in the following situations
until CMS issues a future instruction.
- Non-HIPAA claims may not have the ambulance and chiropractic certification information that is required on the outbound X12N 837 (4010) COB transaction in the loop 2300 elements CR1, CR2 and CRC. The outbound X12N 837 (4010) COB a transaction will not contain these segments when the incoming claim is paper or a non-HIPAA format.
- The article "October 2002 changes for X12N 837 (4010)
Coordination of Benefits" posted on 09.27.02 provides
the information about "gap filling" data when issuing
an outbound X12N 837 (4010) COB transaction to generate files
with complete, HIPAA compliant data elements. In addition to
the information included in the above article:
October 16, 2003. Are you ready? For the latest updates on the October 16 HIPAA deadline and to learn more about transaction and code set requirements, visit the HIPAA Information Center at www.cignamedicare.com/hipaa.
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