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Important Medicare Part B New York News

Due to a system release by our shared maintainer, additional edits will be implemented for July 2004. Changes are made on an as needed basis. As these changes are made, modifications are also made to the Claim Specific Edit document that is found in the Companion Document. For a complete list of all edits, please check our 837 Companion Guide on our website http://www.empiremedicare.com/omnipro/pdf/TPA837-NY.pdf PDF File

Please note: New Edits have been added, edits have been removed and edits have been revised.

  • Edits have been removed. (Plain type)
  • Italic designates changes in the wording found in the document.
  • Bold designates new edits that have been added.
Element Identifier Description Loop Comments Edit Nos Edit Messages
REF Billing Provider Secondary Identification 2010AA      
REF02 Billing Provider Identifier     20263 BILLING PROVIDER UPIN INVALID
           
REF Pay-To Provider Secondary Identification 2010AB      
REF02 Pay-to Provider Additional Identifier     20264 PAY-TO PROVIDER UPIN INVALID
           
PAT Patient Information 2000B      
PAT08 Patient Weight     11314 PT WGT REQD Q9920-Q9940
      REMOVED 30002 PT WGT REQD Q9929-Q9940
           
PAT Patient Information 2000C      
PAT08 PatientInformation     11314 PT WGT REQD Q9920-Q9940
      REMOVED 30005 PT WGT REQD Q9920-Q9940
CLM CLAIMINFORMATION 2300      
CLM05-3 Claim FrequencyCode     11317 REFERENCE NUMBER PRESENT ON ORIGINAL CLM
           
REF OriginalReferenceNumber 2300 Segment must be present if 2300, CLM05-3 =7 11316 ORIGINAL REFERENCE NUMBER REQUIRED
           
REF Clinical Laboratory Improvement Amendment Number 2300      
      Will fire when the claim line has a from date of service equal to or greater than July 1, 2004, 2400 SV101-3 or SV101-4 modifiers = 90, and there is no segment where REF01 = F4. 30038 REF CLIA MISSING
      Will be generated if there is a 2400 REF02 with a REF 01= F4, and there is NOT a 2300 REF01 = X4. 30039 CLAIM CLIA MISSING
           
HI Health Care Information Code 2300      
HI01-2 Diagnosis Code   MEDB - validate against code source 131 (ICD-9-CM) 11304 DIAGNOSIS CD 1 INVALID
      REMOVED 20057 DIAGNOSIS CD 1 INVALID
HI02-2 Diagnosis Code   MEDB - if present validate against code source 131 (ICD-9-CM) 11305 DIAGNOSIS CD 2 INVALID
      REMOVED 20058 DIAGNOSIS CD 2 INVALID
HI03 HEALTH CARE CODE INFORMATION         
HI03-2 Diagnosis Code   MEDB - if present validate against code source 131 (ICD-9-CM) 11306 DIAGNOSIS CD 3 INVALID
      REMOVED 20059 DIAGNOSIS CD 3 INVALID
HI04 HEALTH CARE CODE INFORMATION        
HI04-2 Diagnosis Code MEDB - if present validate against code source 131 (ICD-9-CM) 11307 DIAGNOSIS CD 4 INVALID
      REMOVED 20060 DIAGNOSIS CD 4 INVALID
HI05 HEALTH CARE CODE INFORMATION        
HI05-2 Diagnosis Code   MEDB - if present validate against code source 131 (ICD-9-CM) 11308 DIAGNOSIS CD 5 INVALID
      REMOVED 20061 DIAGNOSIS CD 5 INVALID
HI06 HEALTH CARE CODE INFORMATION        
           
HI06-2 Diagnosis Code   MEDB - if present validate against code source 131 (ICD-9-CM) 11309 DIAGNOSIS CD 6 INVALID
      REMOVED 20062 DIAGNOSIS CD 6 INVALID
HI07 HEALTH CARE CODE INFORMATION        
HI07-2 Diagnosis Code   MEDB - if present validate against code source 131 (ICD-9-CM) 11310 DIAGNOSIS CD 7 INVALID
      REMOVED 20063 DIAGNOSIS CD 7 INVALID
HI08 HEALTH CARE CODE INFORMATION        
HI08-2 Diagnosis Code   MEDB - if present validate against code source 131 (ICD-9-CM) 11311 DIAGNOSIS CD 8 INVALID
      REMOVED 20064 DIAGNOSIS CD 8 INVALID
REF Referring Provider Secondary Identification 2310A      
REF02 Referring Provider Secondary Identifier     20265 REF PROVIDER UPIN INVALID
           
N4 Other Subscriber City/State/Zip 2330A      
N403 Other Insured Postal Zip Code   MEDB - If N402 is a US state, validate N403 is numeric, not all zeroes, not all nines and is either 5 long or 9 long else reject the 2300 level and its subordinate loops 11312 OTH INS ZIP INVALID
      REMOVED 20106 ZIP CODE INVALID
           
REF Referring CLIA Facility Identification 2400      
REF02 Referring CLIA Number    Will be generated if the 2300 REF02 CLIA = the 2400 REF02 CLIA with a REF01 = F4. 11313 REFERRING CLIA EQUAL TO PERFORMING CLIA
           
REF Supervising Provider Secondary Identification 2420D      
REF02 Supervising Provider Secondary Identifier     20266 SUPV PROV UPIN INVALID
           
REF Referring Provider Secondary Identification 2420F      
REF02 Referring Provider Secondary Identifier     20267 REF PROV UPIN INVALID
           
Posted: 07/07/2004

 

CPT codes, descriptions, and other data only are copyright 2003 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.

 
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