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Back  RFI # 1595: K3 Usage for Health Safety Net

Formal vs. Informal Help Informal Formal

Submitter

Laurie Burckhardt

Description

WG2 cochairs were requested to allow the K3 usage for the following:

Massaachusetts has a universal health insurance law, and provides health insurance for residents who do not qualify for Medicaid, but who cannot afford to purchase health insurance, and have no coverage through employment. It is called the "Health Safety Net".

The Commonwealth of Massachusetts has decided that, to save overhead, the Massachusetts Medicaid system, should process health care claims for HSN providers, and all HSN providers must use EDI. There are several additional pieces of information they are required to pick up for HSN, that have no obvious place in the 837. They wanted to use CN1, but some providers objected (correctly) that this was not compliant. Since it is codified data, it also does not belong in NTE.

Requesting the use of K3 to provide the necessary information

Response

ASC X12 TG2 WG2 approves the temporary use of the K3 to support the reporting requirements for Health Safety Net claims using the format defined below. The work group will work with MA Medicaid to find a permanent solution for this business need in a future version.

For 837P claims

K301 First data element = MAHSN (Massachusetts Health Safety Net)

K301 second data element = Deductible Value (20% or 100%)
Code Value = 20
Code Value = 100

Examples:

Partial Deductible Met K3*MAHSN20~
Deductible Met K3*MAHSN100~
Submission 5/24/2012
Status Date 7/13/2012
Status F - Final
Primary References
Document 005010X223
Section2.4