Change Request Detail
No.
1043
Date
7/29/2006
Submitter
Type of Request
Institutional Claim (UB-92)
Status
DSMO Process Completed
Business Reason
X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Claim and Encounter Work Group (WG2) are submitting the following technical Report Type 3 (TR3) as a version upgrade / replacement for the 837 HIPAA transaction, which is currently adopted and implemented using version 004010A1.

The new X12 version is 005010 with Implementation Guide (TR3) designated 005010X223 837 Health Care Claim: Institutional. 
Suggestion
Recommend to NCVHS that the 005010 version of the X12 837 transaction together with its X12 005010 TR3 (Implementation Guide) 005010X223 for the Health Care Claim: Institutional Claims be named to replace the current HIPAA mandated transaction version 4010 and its Implementation Guide designated as 004010X096A1.
DSMO Category
I
Recommendation
Approve. Recommend to NCVHS that the 005010 version of the X12 837 transaction together with its X12 005010 TR3 (Implementation Guide) 005010X223 for the Health Care Claim: Institutional Claims be named to replace the current HIPAA mandated transaction version 4010 and its Implementation Guide designated as 004010X096A1.The DSMO appreciates the added clarity in the 5010 TR3 that will close loopholes and decrease ambiguity of various issues.  Examples identified include, definition of inpatient versus outpatient, harmonization between the 837I 5010 and UB-04 data content, NPI, and COB.  In addition, the DSMO encourages quick adoption of the TR3, which could occur if the streamlined process, as identified by the standards development organizations and WEDI, for modifications to standards is adopted and followed.The DSMO acknowledges that the maintenance of administrative transaction standards is an evolving process and looks forward to continuing to work on improving the standards and the business processes they support.
Appeal Recommendation