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Back  RFI # 1174: Local Codes used by multipayer

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Submitter

ben bartek

Description

In discussion of the 835 the question was raised regarding (state payer) using Local Codes - "In a multipayer program there will be some codes that will not be standard... CMS has been aware of the State Payer / Multi-Payer approach for years..."

Not sure if local codes are allowed on HIPAA compliant transactions, irrespective of payer? Please explain how to accommodate the need to use local codes for State Payer. Need to understand how to handle it in 5010. Can ANSI X12 standards committee provide examle/definition of local codes used in multi-payer approach?

Submitter Assigned Keywords

Local codes in multi-payer

Response

Neither 4010 X091 nor 5010 X221 include any support for local health plan procedure codes. See HIR 1169

Other HIRs related to invalid codes are 366 and 599.
Submission 10/7/2010
Status Date 2/7/2011
Status F - Final
Primary References
Document 005010X221
Section2.4
Page186
Set ID835
Segment Positionsvc01
Segment IDsvc
Element Position01