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There are 571 archived change requests.  The last request to complete the DSMO process is displayed first. Click on the change request number for details. 
11999/30/2016MO HealthNet will be implementing the 271U to receive verified Third Party Liability (TPL) policies from our TPL Vendor. MO HealthNet would like to request that additional code values be added to 2000E/INS02 in the 004010X040 271 Unsolicited Health
119610/9/2014HCFA 1500 Form and the 837P Currently, Field 14 of the CMS 1500 form and its electronic version, the 837P, allows a provider to document the "Date of Current Illness, Injury or Pregnancy (LMP)". It is well known that the LMP is not as reliable a sou
11944/18/2014As I understand it, as part of the Affordable Care Act, CMS has established a requirement for Health Maintenance Organizations offering Medicare programs (Medicare Advantage - MA) to report the patient coinsurance, co-pay and deductible information.
11934/10/2014Request for changing Situational Rule in 005010X222 (Professional 837) TR3 for LIN segment. This request pertains to specialty drugs and specialty drug providers whose scope of practice allows them to provide/administer drugs that are billed to the m
11924/9/2014CMS is seeking a change to the HIPAA standard for the ASC X12 837 professional claim transaction in order to process Medicare subrogation claims. In accordance with 42 U.S.C. § 1395u(b)(6)(B); and 42 C.F.R. 424.66, Medicare is required to pay Part
11898/5/2013Health Care Services: Referral Certification and Authorization - specifically electronic prior authorization by prescribers for the pharmacy benefit. NCPDP has worked for a long time on electronic transactions for the exchange of prior authorizati
11884/19/2013From the response to ASC X12 RFI #1772, "SV2 # of service lines" ... "Guide 005010X221 (Health Care Claim Payment/Advice) section 1.10.2.11 (Claim Splitting) describes how a health plan may split an incoming claim into multiple claims. This proces
11873/5/2013For version 005010, an inconsistency exists in instructions for using the claim level AMT segment when reporting secondary payments. Section 1.10.2.13, page 39, states, "Report the claim coverage amount or service allowed amount in the claim level A
11862/14/2013I am requesting that an XML standard be created for the ASC X12 healthcare-payer related transactions (270/271, 276/277, 278, 820, 834, 835, 837). As we develop real-time services to support the HCR-mandated transactions (270/271, 276/277, etc.) w
118511/13/2012The 5010 ASC X12 837 Professional TR3 does not support identifying both a locum tenens provider and the provider for whom he/she is substituting services. Medicare needs to identify both on a claim in accordance with Medicare law and because of frau
118211/11/2012The National Council for Prescription Drug Programs (NCPDP) is submitting the following request to allow the enhancement of the NCPDP Telecommunication Standard Implementation Guide Version D.Ø named under HIPAA. Description of the problem Governme
118110/30/2012RFI # 1672 was opened with X12 regarding the ability to report NHRIC's in the 837P. The response from X12 was that '....if there is a business need to report this information that it be submitted through the DSMO process....' Description of RFI 1
118010/1/2012In order to remain competitive and to best service its members, it is imperative that payers be able to develop and implement comprehensive specialty pharmaceutical programs that are in accordance and compliance with the standard transaction rules.
11789/28/2012Contract Type code value request for Encounters reporting (Post-adjudicated claims) Transactions: 837 Professional and Dental - 2300/CN101, 2400/CN101 837 Institutional - 2300/CN101 Requesting the use of code value 'FR' (Firm Fixed Price) whi
11769/12/2012ASC X12 TR3 005010X222 for submitting professional claims or encounter reports (837p) permits the inclusion of Condition Information in multiple HI segments with HInn composite -01 containing a value of "BG". When such segments are present, HInn com
11759/12/2012ASC X12 TR3 005010X223 for submitting institutional claims or encounter reports (837i) permits the inclusion of Value Information in multiple HI segments with HInn composite -01 containing a value of "BE". When such segments are present, HInn compos
11748/27/2012Our 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 th
11738/3/2012Submitted 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 Summar
11717/12/2012Massachusetts’ office of Health Safety Net (HSN) is requesting a segment/element to be added to the 837 Professional that would allow the Community Health Centers notifying HSN whether the patient’s deductible is fully met. This information is neede
11663/5/2012Representing dental interests for Transaction 27, the response needs to support the ability to make a lesser allowance toward a submitted service with the difference chargeable to the patient.
116211/18/2011California's Medicaid (Medi-Cal) is requesting an expansion of the ENT01 element at Loop 2000A - Organization Summary from 6 digits to at least a maximum of 7 digits. Medi-Cal currently has one managed care health plan with 880,000 beneficiaries and
11607/22/2011There is a need to data mine claims data for a variety of purposes. One of those purposes is to determine what providers are charging for services (the retail charge). This information is often required under state law to be presented to healthcare
11587/6/2011The NUBC UB-04 Manual maps Form Locator 46, Service Units, to SV205, Service Unit Count, in the 5010 837I TR3. The UB-04 Manual specifies in Form Locator 46 that "A zero or negative value is not allowed.", but the note for SV205 does not contain thi
11575/13/2011Errors noticed in the 005010X223A2 document: 1. Loop 2300 "Claim Information" - Position 1300 - CLM "Claim Information" segment: "TR3 Example: CLM*12345656*500***11:A:1*Y*A*Y*I~" Note that CLM06 is now NOT USED. But the TR3 example has a "Y" in
11482/15/2011Many Medicaid Managed Care Organizations receive payments that exceed the allowed number of digits in the Imp Guide. Work arounds are performed today but these work arounds might be construed as being out of HIPAA compliance.
11472/4/2011Some Medicaid payers always report their payments as a tertiary status even though the claim was submitted how the claim was actualy submitted.
11462/4/2011Have Claim Level Payment amouts equal the total of payments reported at the service level to aid in the processing of and the balancing of remittance transactions. United Healthcare now reports the total they are remitting at the claim level, but pa
11452/4/2011There are state and federal reporting requirements where the claim encounter transaction should contain payment information.
11442/4/2011There is a need for a provider to receive plan administrator information, designated by the sponsor, in a 271 Health Care Eligibility Benefit Response.
11432/4/2011More efficient processing of 835 files
11422/4/2011More efficient processing of 835 files
11412/4/2011The patient reason for visit for all outpatient claims is not valid for many outpatient claims where a service is performed while the patient is not visiting the institution, e.g. outside lab work. The UB04 guide has the list of criteria for valid
11402/4/2011To allow for the accurate and appropriate identification of plan enrollees when "Patient’s Member ID (or the HIPAA Unique Patient Identifier once mandated for use)idenfitication" is not available.
11392/3/2011New Codes and/or New Data Elements Needed to Minimize Use of the MSG Segment in the 271 Transaction
11372/3/2011simplification and reduced cost
11331/28/2011Establish consistent responses in the industry where benefits are administered by Third Parties.
11311/28/2011The requirement to return all plan information prevents streamlining the response. This can also prevent a timely response (under 60 seconds) in a real-time situation. Some payers carry benefit information in separate systems. For example, dental
11301/28/2011Payers need to know the dates that a patient received different levels of care for claims that include multiple inpatient room and board (R&B) revenue codes that distinguish the levels of care. Examples of revenue codes that have different levels of
11291/27/2011Different payer edits can apply to different teeth. The providers need to know the tooth number used to adjudicate the claim line. It could differ from what the provider was expecting. There is no other way in the 835 to communicate this informati
11281/27/2011Clearly and explicitly report the adjudicated patient name when it is different from the submitted patient name.
11271/27/2011Clearly and explicitly report the adjudicated patient name when it is different from the submitted patient name.
11261/27/2011February 4, 2011 deadline to submit revision requests related to the ASC X12 005010 Type 3 Technical Reports (TR3), to be considered for inclusion in 006020. Consistency Needed Across Transactions.
11251/27/2011Allow the provider to tie the forward balance (and subsequent recovery) to the specific claim rather than the payment ID.
11231/27/2011In order to establish uniformity in billing practices among provider where a dependent has a unique Member ID but is not technically the subscriber.
11221/27/2011Provider Taxonomy in Pay-To Provider is used for provider matching process. Some providers bill under multiple specialties.
11211/27/2011In order to establish uniformity in billing practices among provider where a dependent has a unique Member ID but is not technically the subscriber.
11201/27/2011Provider Taxonomy in Pay-To Provider is used for provider matching process. Some providers bill under multiple specialties.
11191/27/2011In order to establish uniformity in billing practices among provider where a dependent has a unique Member ID but is not technically the subscriber.
11181/27/2011Provider Taxonomy in Pay-To Provider is used for provider matching process. Some providers bill under multiple specialties.
111312/17/2010For psychiatric hospitals to bill Medicare covered and non-covered days correctly, the number of lifetime pyschiatric days needs to be returned on the eligibility request. Without this, on the front end staff either have to do a manual eligibility c
111212/8/2010Outdated information regarding Certificate of Medical Necessity forms (CMNs) exists in the 837P 5010 Loops 2000B and 2000C in the PAT07 and PAT08.
111012/3/2010PER Margaret's request.....HELP YOU HELP ME.. Please create and maintain a Group code CARC code and RARC code matching grid (See MN companion guide http://www.health.state.mn.us/asa/mn835guide092909.pdf)
110911/10/2010To provide consistency across transactions for implementers of all transactions.
11069/29/2010The Federal Substance Abuse Rules (FSAR) impose restrictions on the use and disclosure of alcohol and drug abuse patient records that are maintained in connection with the performance of any federally assisted alcohol and drug abuse program. FSAR pro
11058/31/2010To transition from paper to electronic health care transactions and eliminate the numerous phone calls, faxes and e-mails that plague the current system, patients, physicians and other health care providers need to receive all the information necess
10942/18/2010We have a high cost estimate for implementing data element N407 (Country Subdivision Code) in the HIPAA 5010Version and would like to understand the rationale and original intent for adding this data element. Please provide the purpose and who will
109312/29/2009Modifications to the HIPAA implementation guides for electronic health care transactions are needed to allow for the identification of the Universal Product Number (UPN) for medical and surgical supplies. Recent state and federal initiatives1 rela
108810/29/2009Currently, TR3 written with Summary PLB03-1 listing values/qualifiers - includes 'IR' for IRS/federal withholding. No qualifier is available to support STATE withholding. Request qualifier for state withholding to accurately report to provider
108710/23/2009new EB03 codes for screening and diagnostic colonoscopies
10858/31/2009ASC X12 N is requesting the DSMO to consider recommending to NCVHS that the following ASC X12 acknowledgement transactions be considered for adoption as HIPAA required transactions by HHS/CMS/OESS, using version 005010. • ASC X12 999 Acknowledgeme
10806/3/2009In a large provider organization with multiple practice/administration/billing sites, it is often difficult to process refund request letters from the payers in time. A number of times, the letter is received and processed but the payer either does n
10785/18/2009It would be more efficient if each code source listing in the Code Sources Appendix of each Implementation Guide / Type 3 Technical Report always included an Internet Universal Resource Locater (url), plus any needed navigation instructions, for impl
10773/19/2009Newborns which do not have insurance id number and must use mother's id number
10763/4/2009The 835 needs to change CLP06 to allow reporting of payment of HSAs. It needs a new code.
10751/15/2009This issue concerns the 5010 837 Professional TR3. CMS requested changes be made to the next version of the 837P IG regarding Loop 2320 SBR05. Specifically, CMS requested that the values in 2320 SBR05 match the values in the 2000B SBR05 with multiple
107412/31/2008ASC X12 N is requesting the DSMO to consider recommending to NCVHS that the following ASC X12 acknowledgement transactions be considered for adoption as HIPAA required transactions by HHS/CMS/OESS, using version 5010. ASC X12 999 Acknowledgement t
107311/21/2008HIEC codes were merged into HCPCS starting in 2002. See http://www.nhianet.org/resource/hiec/nationalperdiem.cfm for starters.
10719/28/2008We need a compliant way of adjudicating claims for transplant living donor claims. From a provider perspective they would submit the 837 claim correctly reflecting the donor as the patient (Loop 2000C, PAT01=39). However, there is no corres
10707/21/2008Update - to clarify: In support of the X12 work on "005010X214 - 277 Health Care Claim Acknowledgement" and the work that WEDI has accomplished regarding the acknowledgements white-paper - I recommend that via the DSMO process, the "005010X214 -
10694/15/2008The Final Rule for Standards for Electronic Transactions released on August 17, 2000 discusses the standard data content for adopted standards which will facilitate consistent and identical implementation. Although this includes data dictionaries, i
10683/25/2008Several dental providers (oral and maxillofacial surgeons, periodontists, and others) routinely submit claims to medical plans using the 837 Professional Claim. These providers frequently need to designate the tooth number(s) and/or oral cavity area
106710/31/2007X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Eligibility Work Group (WG1) are submitting the following Technical Report Type 3 (TR3) as a version upgrade and replacement for the 270/271 HIPAA Health Care Eligibility Benefi
106610/31/2007X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Claims and Encounter Work Group (WG2) are submitting the following 005010X224A1 Errata Document to compliment the 005010X224 Technical Report Type 3 (TR3) for the 83
106510/31/2007The X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Claim and Encounter Work Group (WG2) are submitting the following 005010X223A1 Errata Document to compliment the 005010X223 Technical Report Type 3 (TR3) for the
106410/31/2007The X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Services Work Group (WG10) are submitting the following 005010X217E1 Errata Document to compliment the 005010X217 Technical Report Type 3 (TR3) for the 278 Healt
106310/6/2007The NCPDP membership is requesting a new standard be named in HIPAA for use in the pharmacy industry – the Post Adjudication Standard Implementation Guide, version 2.Ø. The Post Adjudication Standard Implementation Guide version 2.Ø supports the repo
10603/30/2007X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Premium Payments Work Group (WG4) are submitting the following Technical Report Type 3 (TR3) as a version upgrade and replacement for the 820 HIPAA Premium Payment Transaction (
10592/12/2007Referring number not needed to process claims.
105712/7/2006The NCPDP membership is requesting a new standard be named in HIPAA for use in the pharmacy industry – the Medicaid Subrogation Standard Implementation Guide, version 3.Ø. Medicaid Subrogation is a process whereby Medicaid is the payer of last res
105512/7/2006The NCPDP membership is requesting a new version of the Telecommunication and Batch Standard be named in HIPAA. The Telecommunication Standard Implementation Guide is version DØ. The Batch Standard Implementation Guide is version 1.2, which supports
105410/27/2006X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Enrollments Work Group (WG4) are submitting the following Technical Report Type 3 (TR3) as a version upgrade / replacement for the 834 HIPAA Transaction, which is currently adop
105310/3/2006Would like to request a modification to the format of the PLB segment. PLB for providers are a very manual and tedious process. The use of clearing accounts to post PLB values to cause problems and are not recommended by our accounting and auditin
10529/30/2006X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Services Work Group (WG10) are submitting the folloing Technical Report Type 3 (TR3) as a version upgrade / replacement for the 278 HIPAA transaction, which is curre
10519/30/2006X12 Insurance Subcommittee (N), the Health Care Task Group (TG2) and the Health Care Claims Status Work Group (WG5) are submitting the following Technical Report Type 3 (TR3) as a version upgrade / replacement for the 276/277 HIPAA transactions, whic
10509/15/2006X12 Code Sources 22 and 51 refer to United States Postal Service Publication 65, "National 5-Digit ZIP Code and Post Office Directory". According to the notice at http://www.usps.com/ncsc/addressinfo/zipcodedirectories.htm , "Printed copies of the P
10469/13/2006Some clients in the social services system do not have a first name such as native Americans with names such as 'little bear' 'quiet horse', etc., and prefer to be addressed as such. The Connecticut Social Services System allows a first name to be b
10457/29/2006X12 Insurance Subcommittee (N), the Health Care Task Group (TG2), and the Health Care Claims and Encounter Work Group (WG2) are submitting the following Technical Report Type 3 (TR3) as a version upgrade / replacement for the 837 HIPAA transaction, w
10447/29/2006X12 Insurance Subcommitte (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 as a version upgrade / replacement for the 837 HIPAA transaction, which is c
10437/29/2006X12 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, whi
10427/29/2006X12 Insurance Subcommittee (N), the Health Care Task Group (TG2), and the Claim Payment Work Group (WG3) are submitting the following Technical Report Type 3 (TR3) as a version upgrade/replacement for the 835 HIPAA transaction, which is currently ado
10392/27/2006Request pertains to the 837 and 835 Transactions. Per HIRs 277 and 344, the 835 transaction does not allow a zero dollar amount in the CAS segment however there is no such rule/interpretation of the same requirement in the 837 transaction. Currentl
103412/18/2005As proposed for use in Claims Attachments transactions, LOINC values for identifying attachments are more expressive than report type codes currently used in PWK01. LOINC should be evaluated as a replacement or supplement for the codes presently use
103111/30/2005[The following is a wild and crazy idea to improve the clinical effectiveness of a health care encounter.] In addition to the 'usual' information returned in response to a health care eligibility request, also return a list of all medications dispe
10289/2/2005An 4010X098A1 (claim) file gets created with a billing loop that looks like: NM1*85*2*Name here*****24*111111111~ N3*address1*address2~ N4*city*st*zip~ REF*G2*2222222~ The claim goes through fine. I send over a 4010X093A1 (status) request fo
10277/22/2005Payer entering arrangement with Financial custodian for HDHP (HSA). Financial custodian will issue credit card. Member will use credit card at point of service. Agreement is for payer to send claims liability and cost share data to the Financial cust
10256/15/2005TPA's are legally liable for reporting changes in eligibility to payers even when that change occurs in a prior period of coverage, but there is no facility in 834 to specify a change to a prior period of coverage without terminating coverage. The Lo
10232/3/2005The COBRA Qualifying Event Code (INS07) in the 834 IG does not provide codes for voluntary termination or retirement, which are required qualifying events under COBRA Law.
101712/17/2004Implementation Specification as written can not be used with National Provider Identifier (NPI). Page 73 [unmodified by Addenda] of 004010X061 specifies a value of "65" in ENT03 to indicate the National Employer Identifier is contained in ENT04. A v
101612/16/2004It is not possible to report tooth numbers in the 837 professional transaction for MEDICAL claims. This is principally a wisdom tooth issue but also relates to traumatic dental injuries that fall under the coverage umbrella of a medical carrier. Th
101510/26/2004The way the imp guide is written - there's no way for the payer to say "no middle initial" and not violate an X12 rule. Bottomline to me as a provider - every time a payer does this - my 835 FAILS in validation... and has to be manually handled.