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Back  RFI # 628: State of Claim Jurisdiction

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Submitter

Carter Mark

Description

In P&C there is a need to identify the State of Jurisdiction or a better term may be "State of Compliance" to determine the state that dictates the state compliance requirements that apply to each specific bill (837). The specific details of the claim event will often dictate the state that has jurisdiction over that bill. However, there are other factors such as the Business practices of the payer that may also come into play. The provider, often in coordination with the payer must determine the state of jurisdiction prior to submitting the bill. This information must be provided on the bill. This is especially critical when the bill is sent electronically. The State of Texas is one of the first states to mandate such requirements. There does not appear to be a means to report this data in the current HIPAA Implementation Guides. To meet the Texas and other State requirements we are requesting approval to use the K3 segment in the 2300 Loop for this purpose.

Response

The Workgroup approves this use State of Claim Jurisdiction of the K3 segment in the 2300 loop in the 837P and 837I guides and the NTE segment in the 837D guide in the following formats:

Institutional 4010 = K3*LUTXMN; LU - State; TX is the Jurisdiction =State Code; MN is Accident State

Professional 4010 = K3*LUTX; LU - State; TX - Jurisdictional State; No Accident State in the K3 as the Accident State is in the CLM11-5

Dental 4010 NTE*ADD*LUTX No Accident State in the NTE as the Accident State is in the CLM11-5

The State abbreviation is from Code Source 22 - States and Outlying Areas of the U.S.. If the K3 segment is used for this purpose, the ; sign must not be used as a delimiter.
Submission 2/7/2008
Status Date 6/17/2008
Status F - Final
Primary References
Document 004010X098A1
Sectionk3
Page244
Set ID837