Medicare Claim Status Category And Code Updates (CR11292).pdf

This MLN Matters article (MM11292) from Medicare Administrative Contractors (MACs) informs healthcare providers about updates to Claim Status Category Codes and Claim Status Codes used in ASC X12 276/277 transactions for submitting and responding to health care claims status requests.

Key Points:

- HIPAA Requirement: Healthcare providers must use only National Code Maintenance Committee-approved codes in these transactions, adhering to HIPAA standards.

- Code Updates: New or modified codes are added semiannually by the National Code Maintenance Committee. The June 2019 changes will be available on the codeset website (https://nex12.org/index.php/codes) around July 1, 2019.

- Implementation: MACs must update their systems to use the current code versions by October 7, 2019. They are required to use valid codes in both ASC X12 277 Health Care Claim Status Responses and Healthcare Claim Acknowledgments.

- Accessing Information: The official CR11292 instruction document is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4304CP.pdf. MAC-specific information can be found on their websites listed at http://go.cms.gov/MAC-website-list.

- Disclaimer: The article is for informational purposes only and does not grant rights or impose obligations. It encourages readers to refer to specific statutes and regulations for accurate legal statements.