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MIR-2006-8AB, August 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Claim Status Category Code and Claim Status Code Update
Provider Types Affected
Physicians, providers, and suppliers who submit Health Care Claim Status Transactions to Medicare contractors (carriers, durable medical equipment regional carriers (DMERCs), fiscal intermediaries (FIs), and regional home health intermediaries (RHHIs))
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5137, which provides the October 2006 updates of the Claim Status codes and Claim Status Category codes for use by Medicare contractors (carriers, DMERCs, FIs, and RHHIs).
What You Need to Know
Medicare contractors are to use codes with the “new as of 10/06” designation and prior dates, and they must inform affected providers of the new codes. CR5137 applies to Chapter 31 of the Medicare Claims Processing Manual, Section 20.7 - Health Care Claim Status Category codes and Health Care Claims Status codes for Use with the Health Care Claim Status Request and Response ASC X12N 276/277.
What You Need to Do
Please refer to the Background section of this article for further details.
Background
Claim Status Category codes indicate the general category of a claim’s status (accepted, rejected, additional information requested, and so on). Further detail is provided by the Claim Status code(s).
Under the Health Insurance Portability and Accountability Act (HIPAA), all payers (including Medicare) must use Claim Status Category and Claim Status codes approved by a recognized code set maintainer (instead of proprietary codes) to explain any status of a claim(s) sent in the Version 004010X093A1 Health Care Claim Status Request and Response transaction.
The Health Care Code Maintenance Committee maintains the Claim Status Category and Claim Status codes. The Committee meets at the beginning of each X12 trimester meeting and makes decisions about additions, modifications, and retirement of existing codes.
The updated Claim Status Category and Claim Status codes list is posted three times a year (after each Health Care Code Maintenance Committee X12 trimester meeting) at the Washington Publishing Company Web site at http://www.wpc-edi.com/codes  . At this Web site, select “Claim Status Codes” or “Claim Status Category Codes” to access the updated code list. Included in the code lists are specific details, including the date when a code was added, changed, or deleted. All code changes approved in June 2006 are to be listed to this Web site approximately thirty (30) days after the meeting concludes. For this update, Medicare will begin using the codes in place as of October 2006 in claim status responses issued on or after October 2, 2006. |
Implementation
The implementation date for this instruction is October 2, 2006.
Additional Information
For complete details, please see CR5137, the official instruction issued to your Medicare carrier/DMERC or FI/RHHI regarding changes mentioned in this article. CR5137 may be found at http://www.cms.hhs.gov/Transmittals/downloads/R987CP.pdf  on the CMS Web site.
If you have questions please contact your Medicare carrier/DMERC or FI/RHHI at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5137
Pub. 100-4, Transmittal# R987CP, CR# 5137
Related CR Release Date: June 23, 2006
Effective Date: October 1, 2006
Implementation Date: October 2, 2006
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