Provider Types Affected

Physicians, providers, and suppliers who submit Health Care Claim Status Transactions to Medicare contractors (carriers, Medicare Administrative Contractors (A/B MAC), Durable Medical Equipment Medicare Administrative Contractors (DME MAC), fiscal intermediaries (FI), and Regional Home Health Intermediaries (RHHI))

Provider Action Needed

Impact to You

This article is based on Change Request (CR) 5947 which indicates there have been updates to the Claim Status Category Codes and Claim Status Codes.

What You Need to Know

All code changes approved during the October 2007 meeting of the national Code Maintenance Committee have been posted at http://www.wpc-edi.com/content/view/180/223 and will become effective April 1, 2008.

What You Need to Do

See the Background section of this article for further details.

Background

The Health Insurance Portability and Accountability Act (HIPPA) requires all health care benefit payers, including Medicare, to use only Claim Status Category Codes and Claim Status Codes approved by the national Code Maintenance Committee. These codes are used in the X12 276/277 Health Care Claim Status Request and Response format to explain the status of submitted claim(s).

The decisions about additions, modifications, and retirement of existing Claim Status Category and Claim Status codes made at the October 2007 meeting of the national Code Maintenance Committee were posted at http://www.wpc-edi.com/content/view/180/223/ on November 5, 2007. These updates are effective April 1, 2008 and are to be used in editing of all X12 276 transactions processed by Medicare contractors on or after April 7, 2008.

Additional Information

To see the official instruction (CR5947) issued to your Medicare FI, carrier, DME MAC, or A/B MAC, refer to http://www.cms.hhs.gov/Transmittals/downloads/R1468CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare Carrier, A/B MAC, DME MAC, FI, or RHHI at their toll-free number which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article 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. CPT only copyright 2007 American Medical Association.