Revised American National Standards Institute (ANSI) X12N 837 Institutional Health Care Claim Companion Document for RHHI
MLN Matters articles are subject to revision. We recommend that you visit http://www.cms.hhs.gov/MLNMattersArticles/ frequently to stay abreast of updates. This MLN Matters article relates to Change Request 5334. This is also available at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5334.pdfProvider Types Affected Providers submitting claims to Medicare Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), or Part A/B Medicare Administrative Contractors (A/B MACs) for services provided to Medicare beneficiaries.
Impact on Providers This article is based on Change Request (CR) 5334 which informs your FI, RHHI, or A/B MAC that changes (including National Provider Identifier (NPI) and taxonomy code reporting information changes) are being made to the ANSI X12 837 Institutional Companion Document, which is included with CR 5334 as an attachment.
Background The Health Insurance Portability and Accountability Act (HIPAA) requires that the Centers for Medicare & Medicaid Services (CMS), and all other health insurance payers in the United States, comply with the Electronic Data Interchange (EDI) standards for health care as established by the Secretary of Health and Human Services.
The American National Standards Institute (ANSI) X12N 837 implementation guides have been established as the standards of compliance for submission of claims for all services, supplies, equipment, and health care other than retail pharmacy prescription drug claims. Implementation guides for each ANSI X12N transaction adopted as a HIPAA standard can be found at the following Web site:
http://www.wpc-edi.com.
The ANSI X12 837 Institutional Companion Document includes a set of statements, which supplements the requirements (but does not contradict) the X12N 837 Institutional Implementation Guide, and it clarifies Medicare contractor (FI/RHHI/A/B MAC) expectations regarding data submission, processing, and adjudication.
Change Request (CR) 5334: - Provides your FI, RHHI, or A/B MAC with changes needed to the ANSI X12 837 Institutional Companion Document as an attachment, and
- Instructs your FI, RHHI, or A/B MAC to use these changes (which include adding a requirement to report, as of May 23, 2007, the National Provider Identifier (NPI) and taxonomy code reporting information) to revise/update your ANSI X12 837 Institutional Companion document.
The revised/updated ANSI X12N 837 Institutional Companion Document will be available through your Medicare FI, A/B MAC, or RHHI.
Implementation The implementation date for CR5334 is January 2, 2007.
Additional Information For complete details, please see the official instruction issued to your FI, RHHI, or A/B MAC regarding this change. That instruction may be viewed at
http://www.cms.hhs.gov/Transmittals/downloads/R1116CP.pdf on the CMS Web site.
If you have any questions, please contact our office at 1-866-801-5301.