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Back  RFI # 715: 835 - OH House Bill125

Formal vs. Informal Help Informal Formal

Submitter

Cathy Plattner

Description

Business Reason:
Need assistance please with a House Bill 125 (OH HB125) that reads:

Sec. 3963.07.
(A) All remittance notices sent by a payer, whether written or electronic, shall include both of the following:
(1) The name of the payer issuing the payment to the participating provider;
(2) The name of the contracting entity through which the payment rate and any discount are claimed, if the contracting entity is different from the payer.
(B) Division (A) of this section takes effect March 31, 2009.

Need input on where item A2 above is sent in 835 v 4010A1 AND v5010. Is the Loop 2100 - Carrier Crossover Name appropriate for this purpose?

Response

Both the 4010 and 5010 guides for the 835 have no direct support for the contracting entity name. Usage of the 2100 loop Crossover Carrier Name is inappropriate for that function.
Both versions of the 835 support an Other Claim Related Identification REF segment in the 2100 loop that includes a value for Class of Contract Code. The health plan can populate
that with any identification (including name) that they deem appropriate and fits within the size limitation. While it is our understanding that the Federal Regulation for HIPAA supercedes state regulations to the contrary, regulatory aspects of this question should be directed to askhipaa@cms.hhs.gov.
Submission 12/16/2008
Status Date 3/2/2009
Status F - Final
Primary References
Document 004010X091A1
SectionLoop2100
Page114
Set IDNM1