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Back  RFI # 614: 837I - QTY on Outpatient Claim

Formal vs. Informal Help Informal Formal

Submitter

Dan Sullivan

Description

Our policy as a payer is to require 'covered days' (to mean the number of visits) on some outpatient claims (e.g., Home Health) in some circumstances, namely when a co-payment is due. We use the covered days to calculate the number of co-payments due.

One of our providers is stating that QTY should not be used on outpatient claims at all. While there may be other ways to collect or derive what we are getting from QTY, our question is whether this is truly a compliance issue.

We believe that the first situational note allows us to use QTY the way we are:

"Use the Quantity segment at the claim level Loop ID-2300 to transmit quantities that apply to the entire claim."

Submitter Assigned Keywords

QTY, covered days, outpatient

Response

The X096A1 Institutional Guide requires the Claim Level QTY Segment on inpatient claims or inpatient encounters “when covered, co-insured, life-time reserved or non-covered days are being reported". It does not specifically exclude its use for other purposes.
This HIPAA Implementation Guide Interpretation function is intended to provide clarification of the contents of the HIPAA guides. Any compliance questions should be addressed to the HIPAA enforcement function at CMS.
Submission 11/27/2007
Status Date 1/18/2008
Status F - Final
Primary References
Document 004010X096A1
Section3
Page306
Set ID837I
Table2
Loop2300
Segment Position240
Segment IDQTY
Element Position02
Industry NameClaim Days Count (Covered Days)