Medlearn
Matters…Information for Medicare
Providers
(Issued by the Centers for
Medicare & Medicaid
Services)
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April 2005
Update of Health Care Claims Status Codes and Health Care
Claims Status Category Codes for Use with the Health Care
Claim Status Request and Response ASC X12N
276/277
Provider Types Affected
Physicians, providers, and suppliers
Provider Action Needed
Physicians, providers, and suppliers should note that
this article and related CR 3566 provide information
regarding updates to the Health Care Claims Status Codes
and Health Care Claims Status Category Codes for use in
requesting information about the status of claims with
the Health Care Claim Status Request and Response ASC
X12N 276/277 transactions. Effective April 1, 2005,
Medicare carriers and intermediaries will use codes with
the “new as of June 2004” designation and
prior dates.
Background
The Health Insurance
Portability and Accountability Act (HIPAA) directs that
all health care plans to use national standards for the
transfer of certain health care data. HIPAA requires all
payers to use the applicable health care claims status
category codes and health care claim status codes of the
American National Standards Institute (ANSI) American
Standards Committee (ASC) X12N. Medicare carriers and
intermediaries must periodically update their claims
system with the most current health care claims status
category codes and health care claim status codes for use
with the Health Care Claim Status Request and Response
ASC X12N 276/277 transaction. These transactions are used
by providers to inquire about the status of claims they
have submitted and by health plans to reply to such
inquiries.
Medicare contractors (carriers, Durable Medical
Equipment Regional Carriers, intermediaries, and Regional
Home Health Intermediaries) must update their claims
systems to ensure that the current version of these codes
is used in their claim status responses. By April 4,
2005, Medicare contractors are to use the “new as
of June 2004” or a prior date designation. These
codes may be found at: http://www.wpc-edi.com/codes/Codes.asp
Not all of the codes apply to Medicare. Thus, Medicare
contractors are not required to accommodate codes that do
not apply to Medicare in their 277 responses.
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Note: Medicare contractors
must comply with the requirements contained in
the version 4010A1 ASC X12 276/277 IG and must
use valid Health Care Claim Status Category Codes
and Health Care Claim Status Codes when sending
277 responses.
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Additional Information
The
Medicare Claims Processing Manual (Pub. 100-04), Chapter
31 (ANSI X12N Formats), Section 20 (ANSI X12N 276/277
Claims Status Request/Response Transaction Standard),
Subsection 20.7, has been revised. The revised manual
page(s) are attached to the official instruction released
to your Medicare carrier/intermediary. You may view that
instruction at: http://www.cms.hhs.gov/Transmittals/downloads/R406CP.pdf
For additional information on claims status codes and
claims status category codes, you may also refer to
Medlearn Matters article MM3361, which is available at:
http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM3361.pdf
The code sets for use with the 276/277 are the Health
Care Claims Status Category Codes and Health Care Claim
Status Codes found at: http://www.wpc-edi.com/codes/codes.asp
If you have any questions, please contact your
carrier/intermediary at their toll-free number, which may
be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf
Disclaimer
Medlearn Matters articles are
prepared as a service to the public and are not intended
to grant rights or impose obligations. Medlearn Matters
articles 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.
Related Change Request (CR) #:
3566
Medlearn Matters Number: MM3566
Related CR Release Date: December 17,
2004
Related CR Transmittal #: 408
Effective Date: April 1,
2005
Implementation Date: April 4, 2005
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