Change Request Detail
No.
1174
Date
8/27/2012
Submitter
Type of Request
Professional Claim (HCFA 1500)
Status
DSMO Process Completed
Business Reason
Our company is a vision health care organization and utilize the 837 to complete claims transactions.  In the vision world we communicate lens prescription information on our claims.  Prescription data is the patients eye sight information and not the typical drug prescription.  I would like to suggest that we enhance the 837 for vision claims to have a section added for this data or even create a 837-V.
Suggestion
Either create a 837-V or modify the 837 to gather Vision Rx data. 



Loop ID 2400 Service Line Info NTE segment.  This segment has two elements:
                
1.  NTE01 (Note Reference Code) --> This value should always be:  ADD (for additional information).
2.  NTE02 (Note Description)         --> This is an 80 character alpha/numeric field.
                
The format for NTE02 would be as follows:



Position    Length    From    To    Description    Value / Format
1    1    1    1    Right Plano    Y or N
2    1    2    2    Left Plano    Y or N
3    1    3    3    Right Sphere Sign    + or -
4    6    4    9    Right Sphere    xxx.xx
10    1    10    10    Right Cylinder Sign    + or -
11    6    11    16    Right Cylinder    xxx.xx
17    3    17    19    Right Axis    xxx
20    7    20    26    Right Prism    xxxx.xx
27    1    27    27    Right Base    x
28    1    28    28    Left Sphere Sign    + or -
29    6    29    34    Left Sphere    xxx.xx
35    1    35    35    Left Cylinder Sign    + or -
36    6    36    41    Left Cylinder    xxx.xx
42    3    42    44    Left Axis    xxx
45    7    45    51    Left Prism    xxxx.xx
52    1    52    52    Left Base    x
53    5    53    57    Right Add    xx.xx
58    5    58    62    Left Add    xx.xx
63    18    63    80    Blank    
DSMO Category
D
Recommendation
Disapprove. The DSMO members reached out but did not receive business justification from the industry for inclusion of vision prescription information as necessary for the adjudication of vision claims.
Appeal Recommendation