HIPAA: SUMMARY OF ADDENDA (4010A1) CHANGES

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HIPAA: SUMMARY OF ADDENDA (4010A1) CHANGES

X12N 837 Institutional IG Addenda Items	X12N 276 IG DSMO Addenda Items	X12N 277 IG DSMO Addenda Items
X12N 270 IG DSMO Addenda Items	X12N 271 IG DSMO Addenda Items	X12N 835 IG DSMO Addenda Items

X12N 837 Institutional IG Addenda Items

Original IG Page	Description of Change
60	The value of REF02 is changed to "004010X096DA1" for pilot mode and "004010X096A1" for production mode.
71	The provider specialty segment requirement has been modified to include two requirements that must be met if the information is sent.
106	2000B PAT segment was removed.
144	The usage of data elements PAT07, PAT08, and PAT09 was changed from SITUATIONAL to NOT USED.
119 & 155	Property and Casualty Number requirement revised to state not required for HIPAA.
161	The usage of data composite CLM11 was changed from SITUATIONAL to NOT USED.
163	The usage of data element CLM12 was changed from SITUATIONAL to NOT USED.
189	Documentation Identification Code repeat was changed from 1 to 2. Note added for REF02.
210	Home Health note changed to require when applicable.
227	Principal, admitting, e-code and patient reason for visit diagnosis information requirement changed from "required" to "situational" and note added to clarify when required.
321	2310A Attending physician NM1 note changed.
324	2310A Attending physician specialty note added to state it is required if adjudication is known to be impacted.
328	2310B Operating physician NM1 note changed.
331	2310B Operating physician specialty information (PRV) was removed.
335	2310C Other provider NM1 notes changed.
338	2310C Other provider specialty information (PRV) was removed.
342 - 348	Data segments for referring provider information were removed.
352	Service facility specialty information (PRV) was removed.
436 - 439	Data segments for other payer referring provider information were removed.
446 - 447	Note added to the data element SV202-1 product service qualifier to state that the HIEC codes are not used under HIPAA. The NDC code formats N1, N2, N3, and N4. were removed. NDC information was moved to the LIN segment. New note added to state HCPCS are required for outpatient claims and reported only when an appropriate code exists for that service.
450	Segment SV4 was removed.
456	Service line date note added to state that it is not used if Assessment date is used.
458	Assessment date note added to state that it is not used if Service line date is used.
	New loop added, 2410 (Drug Identification). New segments added to loop are LIN (Drug Identification), CTP (Drug Pricing), and REF (Prescription Number). The LIN segment will house the NDC.
462	Attending physician name note added to state that it is required if adjudication is known to be impacted.
465	2420A Attending physician specialty information (PRV) was removed.
469	Operating physician name note changed to state it is required if adjudication is known to be impacted.
472	2420B Operating physician specialty information (PRV) was removed.
476	Other provider name note changed to state that it is required if adjudication is known to be impacted.
479	2420C Other provider specialty information (PRV) was removed.
483 - 489	Data segments for referring provider information were removed.
491	Note added to the data element SVD03-1 product service qualifier to state that the HIEC codes are not used under HIPAA. The NDC code formats N1, N2, N3, and N4 were removed. NDC information was moved to the LIN segment.
	New segment HCP (Line Pricing/Repricing Information).
A.6	Added new note in A.1.3.1.2 to limit decimal data elements in DE 782 (monetary) to 10 characters.
B.8	Replaced example for GS segment.
B.9	Code value in GS08 was changed to "004010X096A1" to reflect new addendum version.

X12N 276 IG DSMO Addenda Items

Original IG Page	Description of Change
74	Loop repeat changed to "1"
77	Claim submitter trace number usage change to "situational"
78, 80, & 82	Note 3 & 4 added. The REF in 2200 cannot exceed 3.
103	Note 1 changed to state use only if patient is other than the subscriber. Note 4 added to state the REF in 2200 cannot exceed 3.
	New REF segment added to report the group number
98	Loop repeat changed to "1"
103	Note changed

X12N 277 IG DSMO Addenda Items

Original IG Page	Description of Change
148	Subscriber demographic information changed from required to situational. New note added.
150	Loop repeat changed to "1".
153	Claim submitter trace number usage changed to situational.
165, 167 &169	Note 3 added. The REF in 2200 cannot exceed 3.
194	Dependent Name loop repeat changed to "1".
103	Note changed
A.6	Added new note in A.1.3.1.2 to limit decimal data elements in DE 782 (monetary) to 10 characters.
B.8	Replaced example for GS segment.
B.9	Code value in GS08 was changed to "004010X093A1" to reflect new addendum version.

X12N 270 IG DSMO Addenda Items

Original IG Page	Description of Change
52	Added new code value "XV" for Plan ID (NM108)
96 & 138	Added new code value and N4 (NDC). Deleted code value ND.

X12N 271 IG DSMO Addenda Items

Original IG Page	Description of Change
197	Added new code value "CT" to REF01.
231 & 308	Added new code value IV and N4 (NDC). Deleted code value ND.
262 & 338	Added two new code values to PRV01.
275	Added two new code values to REF01.
A.6	Added new note in A.1.3.1.2 to limit decimal data elements in DE 782 (monetary) to 10 characters.
B.8	Replaced example for GS segment.
B.9	Code value in GS08 was changed to "004010X092A1" to reflect new addendum version.

X12N 835 IG DSMO Addenda Items

Original IG Page	Description of Change
63	Changed note in N103 to state required if the NPI is transmitted in N104 and required if it is mandated.
140 & 143	Added new code value IV. Deleted code values N1, N2, N3 an ND.
166	Added new code value "AH" to PLB03-1.
A.6	Added new note in A.1.3.1.2 to limit decimal data elements in DE 782 (monetary) to 10 characters.
B.8	Replaced example for GS segment.
B.9	Code value in GS08 was changed to "004010X091A1" to reflect new addendum version.

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