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Back  RFI # 902: Advanced Billing Concept Codes

Formal vs. Informal Help Informal Formal

Submitter

joanne hoagland

Description

PLEASE REFER TO HIR #901 - JUST OPENED FOR 837 iNSTITUTIONAL 5010X223. THAT SAME INTERPRETATION IS NEEDED FOR 837 PROFESSIONAL 5010X222. THANK YOU.

Response

Based on CMS FAQ 2458 the pilot project approved in January 2003 by the Secretary of HHS was discontinued on October 16, 2006. Therefore, as of this date, covered entities may not use the codes in HIPAA transactions, including those covered entities who registered for the pilot. Covered entities and non-covered entities may use the codes for non-HIPAA transactions.

The intent of the 837 workgroup was to only allow Advanced Billing Concepts Codes as defined within the note for all applicable ABC code qualifiers. The CAH qualifier which also represents ABC Codes should have included this note. Since the pilot was discontinued after the 5010 837 Professional implementation guide was published the workgroup will consider whether or not to leave the ABC Code qualifiers (where applicable) in a future version of the Professional 837 TR3.
Submission 11/4/2009
Status Date 1/7/2010
Status F - Final
Primary References
Document 005010X222
Sectionvarious
Page353
Set ID837 P