MLN Matters® Number: MM6609
Related Change Request (CR) #: 6609
Related CR Release Date: August 14, 2009
Effective Date: October 1, 2009
Related CR Transmittal #: R1797CP
Implementation Date: October 5, 2009
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 (DME MACs) for Medicare beneficiaries are affected.
Provider Action Needed
This article, based on CR6609, 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 June 2009 meeting of the national Code Maintenance Committee and code changes approved at that meeting were posted at www.wpc-edi.com/content/view/180/223/ on the Internet on or about June 30, 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.
Additional Information
If you have any questions, please contact our provider service center at our toll-free number, (877) 567-9249 (for North Carolina and South Carolina Part A providers) or (866) 801-5301 (for home health and hospice providers).
The official instruction, CR6609, issued to your Medicare contractor regarding this change may be viewed at www.cms.hhs.gov/Transmittals/downloads/R1797CP.pdf (PDF, 104 KB) 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.