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Back  RFI # 1794: APR-DRG & EAPG returned on 835

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Submitter

Dianne Hagen

Description

Does the ASCX12 committee have any plans to incorporate the ability to return the APR-DRG or EAPG payment codes onto the 835 ERA?
We are starting to use these types of payment methodology with our providers, and they have expressed their desire to see these codes being returned on the 835.
I've done research on the files & discussion board, and have noticed that there has been allot of discussion around this topic since 5010 implementation.
It is our understanding that the APR-DRG cannot be returned in the current DRG CLP11 & 12 segment as the APR-DRG is not of the same code Source 229 set as the DRG. (HIR 999).
Can you please advise if there has been any decision to enhance the 835 ERA to be able report back the APR-DRG or EAPG.
Thank you

Submitter Assigned Keywords

835 APR-DRG EAPG

Response

Yes, ASC X12 has addressed this issue in the 006020X258 version of the 835 Technical Report Type 3. In version 006020 and later, both the DRG value and the type of DRG will be reported. The type of DRG will not be restricted to code source 229.
Submission 5/15/2013
Status Date 7/1/2013
Status F - Final
Primary References
Document 005010X221
SectionCLP