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Back  RFI # 914: HIPAA 5010 835 requirements

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Submitter

joanne hoagland

Description

As part of the 5010 mandate, is the 835 transaction expected to send out full field sizes as they were submitted on the 837 claim?? For example, if the 837 claim was submitted in version 5010, and a last name was submitted with 60 characters...........is the 835 sent out in version 5010 expected to include that last name with the full 60 characters?? To be 5010 compliant, payers will accept the full 60 characters on the 837, but may not utilize the full 60 characters when adjudicating the claim. Therefore the 835 to be developed as a result of this claim adjudication may not include the full 60 characters, and the payer will have to find another way to get the full 60 characters out on the 835. Is that the intent?

Submitter Assigned Keywords

HIPAA 5010 835 - returning full field sizes

Response

For any element that is expressly returning the information submitted on the claim, the 835 must contain the same information as was received on the claim, even if the payer didn't use all of that information. For your example, if the patient last name from the claim was 60 characters long but the payer's system only uses 25 characters, then the 835 must contain the submitted 60 characters. Please note that the patient name information also states a retail pharmacy specific exception that allows omission of that specific information.
Submission 12/2/2009
Status Date 4/6/2010
Status F - Final
Primary References
Document 005010X221
Sectionn/a
Pagen/a
Set ID835