EDI Billing Updates

EDI Billing Updates (Veterans Health Administration)

EDI Billing Updates as for ASC X12N 5010 Health Care Claim (837) Transactions in the Veterans Health Administration EDI billing system include the following changes:

  • An inpatient institutional 837 transaction no longer requires a POA for each diagnosis
  • An inpatient admission date can no longer be transmitted on outpatient claims
  • All Rate Types for which the responsible party is equal to insurer can now be transmitted electronically when appropriate
  • Institutional 837 transactions can now transmit up to twenty-five procedure codes
  • Institutional 837 transactions can now transmit up to 12 External Cause of Injury codes

Enhanced CMS-1500 Printed Claim Form

The CMS-1500 Printed Claim Form has been updated to comply with the National Uniform Claim Committee (NUCC) standards:

  • The Event Date will no longer be used as a default value for Box 14. If there is no Occurrence Code 10 – Last Menstrual Period Date or Occurrence Code 11 – Onset of Illness Date on the claim, no date or date qualifier will print in Box 14
  • The Timeframe of Bill value of either 7 – REPLACEMENT CLAIM or 8 – VOID/CANCEL PRIOR CLAIM will print in Box 22 (left-hand side) and the Internal Control Number (ICN) from the payer will print in Box 22 (right-hand side) for replacement claims 7 or 8.

Insurance Company Entry/Edit

The Insurance Company Editor has been modified to prevent the creation of new 5 character ZIP codes or 9 digit codes which include invalid final four digits (0000 or 9999). This change will affect the following addresses:

  • Main Mailing Address
  • Inpatient Claims Office Address
  • Appeals Office Address
  • Inquiry Office Address
  • Outpatient Claims Office Address
  • Prescription Claims Office Address

This change will not affect existing ZIP code values or usage unless someone attempts to update the current value. All new ZIP codes should be 9 valid digits. If users do not enter the correctly formatted data, they will not be able to proceed.

Learn more about Health Care Claim billing and HIPAA EDI at our online webinars.

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