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Back  RFI # 1399: Jurisdictional state 5010

Formal vs. Informal Help Informal Formal

Submitter

Chip Evelsizer

Description

X12 previously approved a K3 segment to carry the state of claim jurisdiction value. In the RFI 628 response, X12 specified the 4010A1 837 transactions. Generally, approved K3 usages are carried forward to future versions of guides unless a permanent solution is approved. In this case, in addition to the jurisdiction state, the approved 4010A1 K3 also included the accident state for Institutional since the accident state was not included and an NTE usage for Dental since a K3 was not included.

Since the 5010 Institutional TR3 now allows for accident state (Automobile only) and the 5010 Dental includes the K3, a pure carry forward of the previous requirements may not be appropriate. Will it be necessary for X12 to change the current design to only use the K3 in all three 5010 837 TR3s and remove accident state from the Institutional K3?

Submitter Assigned Keywords

Jurisdiction K3

Response

Reporting of Auto Accident State in version 5010 must always be reported external to the K3 segment. For professional and dental claims, the auto accident state must be reported in the 2300 loop CLM11-04 element. For Institutional claims, the auto accident state must be reported in the 2300 loop Auto Accident State REF segment. Submitters continue to use the K3 Segment to support the jurisdictional state for property and casualty and worker's compensation claims in version 5010 of the institutional and professional 837 transactions. Also, use claim level (2300) K3 segment in version 5010 of the dental 837 transaction, discontinuing use of the NTE segment, to submit the jurisdictional state for property and casualty and worker's compensation claims.

For clarity, jurisdictional state examples are provided below.

5010 837P - K3*LUTX LU - State; TX is the Jurisdiction state code
5010 837I - K3*LUTX LU - State; TX is the Jurisdiction state code
5010 837D - K3*LUTX LU - State; TX is the Jurisdiction state code

Note - while an auto accident may occur in a certain state, the jurisdictional state may not be the same state as where the accident occurred.
Submission 9/7/2011
Status Date 10/24/2011
Status F - Final
Primary References
Document 005010X222
Section2.4