RE: 835 Medical Code Set Dilema

[WandaP Corr]

How will you reject paper claims that will not go through the translator? >>> [EMAIL PROTECTED] 2/4/02 7:38:49 PM >>> How about rejecting the claim transaction set with a data element note (in Functional Acknowledgment) saying - Invalid code value (Data element syntax error code - 7) Raj Thuppanna Per-se Technologie Phone: 770 444 4468 -----Original Message----- From:     Anthony Barone [mailto:[EMAIL PROTECTED]] Sent:    Monday, February 04, 2002 7:03 PM To:    [EMAIL PROTECTED] Cc:    [EMAIL PROTECTED] Subject:    835 Medical Code Set Dilema Transaction and Codeset Resources, 835 Denied Medical Code Dilemma - Can noncompliant medical codes go out on the 835? Situation:  HIPAA presents some challenges around the interpretation of what valid medical codes can and can't be returned on an 835 ERA. Scenario:  A claim comes in via paper or EDI and a valid 835 must be produced. Question:  If any medical code is denied since it did not follow one of the HIPAA regulated code sets, is it "compliant" to send the denied noncompliant code in the SVC segment accompanied by claim adjustment information in the CAS segment?  Also, if we are able to send back the noncompliant code, what Product/Service ID qualifier should be used?  Should it be the original that was submitted on the claim or ZZ since the code is not actually a valid NUBC (qualifier = NU), HCPCS (qualifier = HC) or any other compliant code set for the matter? Here is what we do know:  Within the HIPAA claim adjustment reason codes, message code B18 sates - Payment denied b/c this procedure code/modifier was invalid on the date of service or claim submission.  This implies that HIPAA would allow such noncompliant codes to be populated in the 835.  Any insight would be appreciated. Thanks, Tony _________________________________________________________________ Send and receive Hotmail on your mobile device: http://mobile.msn.com ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.