MLN Matters® Number: MM6723
Related Change Request (CR) #: 6723
Related CR Release Date: December 14, 2009
Effective Date: January 1, 2010
Related CR Transmittal #: R1874CP
Implementation Date: January 4, 2010
Note: This article was revised on December 15, 2009, to reflect a revised CR 6723 that was issued on December 14. The CR release date, transmittal number, and the Web address for accessing CR 6723 were revised. All other information remains the same.
Provider Types Affected
All physicians, providers and suppliers submitting claims to Medicare contractors (fiscal intermediaries (FI), Regional Home Health Intermediaries (RHHI), carriers, A/B Medicare Administrative Contractors (MAC) and Durable Medical Equipment MACs or DME MACs) for Medicare beneficiaries are affected.
Provider Action Needed
This article, based on CR6723, explains that the Claim Status Codes and Claim Status Category Codes for use by Medicare contractors with the Health Claim Status Request and Response ASC X12N 276/277 were updated during the September 2009 meeting of the national Code Maintenance Committee and code changes approved at that meeting were posted at http://www.wpc-edi.com/content/view/180/223/ on the Internet on November 1, 2009. All providers should ensure that their billing staffs are aware of the updated codes.
Background
The Health Insurance Portability and Accountability Act (HIPAA) requires all health care benefit payers to use only Claim Status Category Codes and Claim Status Codes approved by the national Code Maintenance Committee in the X12 276/277 Health Care Claim Status Request and Response format adopted as the standard for national use (004010X093A1). These codes explain the status of submitted claim(s). Proprietary codes may not be used in the X12 276/277 to report claim status. All code changes approved during the September 2009 committee meeting were posted at http://www.wpc-edi.com/content/view/180/223/ on November 1, 2009. Medicare will implement those changes on January 4, 2010 as a result of CR6723.
Additional Information
If you have questions, please contact the Palmetto GBA Provider Contact Center at their toll-free number, (866) 801-5301.
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.