Change Request Detail
No.
1173
Date
8/3/2012
Submitter
Type of Request
Payment of a Health Care Claim
Status
DSMO Process Completed
Business Reason
Submitted on behalf of:
Mickey Lourenco
Care New England, Medicare Supervisor
mlourenco@carene.org

The X12 implementation of the 5010A.1 format of an 835 file has created a tremendous issue and burden for our hospital regarding the Bill Summary pages TS306-TS312 Monetary Amount.  Much of the Provider Summary Information loops as in my issue of the 2000.TS3, was removed as "Usage change to Not Used".

So, it was changed from summarizing this information on the Bill Summary pages, by Net Reimbursement (TS309), Cost Outlier information, etc., to not providing this information at all the fields are now blank.

This is a very important information and we monitor these fields daily, as well as, report this information to the highest levels of our organization.    Please consider providing this again. 
Suggestion
null
DSMO Category
D
Recommendation
Disapprove.  The DSMO recommends that the submitter consider opening a new request that clearly states the business reason for the proposed change, the specific proposed change, and information on how current reports/data supplied fail in providing the requested data.
Appeal Recommendation