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MIR-20007-1AB, January 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Revised American National Standards Institute (ANSI) X12N 837 Institutional Health Care Claim Companion Document
Provider Types Affected
Providers submitting claims to Medicare Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), or Part A/B Medicare Administrative Contractors (A/B MACs) for services provided to Medicare beneficiaries
Impact on Providers
This article is based on Change Request (CR) 5334 which informs your FI, RHHI, or A/B MAC that changes (including National Provider Identifier (NPI) and taxonomy code reporting information changes) are being made to the ANSI X12 837 Institutional Companion Document, which is included with CR 5334 as an attachment.
Background
The Health Insurance Portability and Accountability Act (HIPAA) requires that the Centers for Medicare & Medicaid Services (CMS), and all other health insurance payers in the United States, comply with the Electronic Data Interchange (EDI) standards for health care as established by the Secretary of Health and Human Services.
The American National Standards Institute (ANSI) X12N 837 implementation guides have been established as the standards of compliance for submission of claims for all services, supplies, equipment, and health care other than retail pharmacy prescription drug claims. Implementation guides for each ANSI X12N transaction adopted as a HIPAA standard can be found at the following Web site: http://www.wpc-edi.com  .
The ANSI X12 837 Institutional Companion Document includes a set of statements, which supplements the requirements (but does not contradict) the X12N 837 Institutional Implementation Guide, and it clarifies Medicare contractor (FI/RHHI/A/B MAC) expectations regarding data submission, processing, and adjudication.
Change Request (CR) 5334:
- Provides your FI, RHHI, or A/B MAC with changes needed to the ANSI X12 837 Institutional Companion Document as an attachment, and
- Instructs your FI, RHHI, or A/B MAC to use these changes ( which include adding a requirement to report, as of May 23, 2007, the National Provider Identifier (NPI) and taxonomy code reporting information) to revise/update your ANSI X12 837 Institutional Companion document.
The revised/updated ANSI X12N 837 Institutional Companion Document will be available through your Medicare FI, A/B MAC, or RHHI.
Implementation
The implementation date for CR5334 is January 2, 2007.
Additional Information
For complete details, please see the official instruction issued to your FI, RHHI, or A/B MAC regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1116CP.pdf  on the CMS Web site.
If you have any questions, please contact your FI, RHHI, or A/B MAC at their toll-free number, which may be found on the CMS Web site at: http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  .
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: MM5334
Pub. 100-4, Transmittal# R1116CP, CR# 5334
Related CR Release Date: November 24, 2006
Effective Date: January 1, 2007
Implementation Date: January 2, 2007
Flu Shot Reminder
Flu season is here! Medicare patients give many reasons for not getting their flu shot, including -- “It causes the flu; I don’t need it; it has side effects; it’s not effective; I didn’t think about it; I don’t like needles!” The fact is that out of the average 36,000 people in the U.S. who die each year from influenza and complications of the virus, greater than 90 percent of deaths occur in persons 65 years of age and older. You can help your Medicare patients overcome these odds and their personal barriers through patient education. Talk to your Medicare patients about the importance of getting their annual flu shot--and don’t forget to immunize yourself and your staff.
Protect yourself, your patients, and your family and friends. Get Your Flu Shot.
Remember - Influenza vaccination is a covered Part B benefit. Note that influenza vaccine is NOT a Part D covered drug. For more information about Medicare ’s coverage of adult immunizations and educational resources, go to CMS’s Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf .
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