Commonwealth of Massachusetts Executive Office of Health and Human Services Changes to Companion Guides January 2012 MassHealth Changes to Companion Guides ANSI ASC X12N (Version 005010) January 12, 2011 Commonwealth of Massachusetts Executive Office of Health and Human Services Changes to Companion Guides January 2012 Table of Contents 1.0 Introduction ................................................................................ ..........................................................................2 1.1 What Is HIPAA?.......................................................................... ......................................................................2 2.0 Changes ................................................................................ ................................................................................ .2 -i- Commonwealth of Massachusetts Executive Office of Health and Human Services Changes to Companion Guides January 2012 1.0 Introduction 1.1 What Is HIPAA? The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires MassHealth, and all other health-insurance payers in the United States, to comply with the electronic data interchange (EDI) standards for health care as established by the Secretary of Health and Human Services (HHS). The standard for electronic health care transactions adopted by HHS is ANSI ASC X12N Version 005010, and is effective January 1, 2012. 2.0 Changes The following changes have been made to the companion guides. Please refer to these changes when constructing MMIS HIPAA batch transactions. Please Note: Effective 07/01/2011, Appendix A: Acknowledgements was added to all companion guides, detailing the use of TA1/999 acknowledgements for 5010. 270/271 Companion Guide Item Date Loop Segment Element Name Change 1. 07/2011 2110C REF 01 Reference Identification Qualifier Changed value from GP to 6P. 2. 07/2011 2110C REF 02 Reference Identification Removed value A6. 3. 07/2011 ---- GE 02 Number of Transaction Sets Included Added segment. 4. 07/2011 ---- IEA 01 Number of included Functional Groups Added segment. 5. 10/2011 2110C REF 01 Reference Identification Qualifier Removed values F6, and A6. 6. 10/2011 2110C REF 02 Reference Identification Removed value F6. 7. 12/2011 ---- GE 01 Number of Transaction Sets Included Corrected segment ID. 8. 12/2011 2100C REF 02 Identification Code Removed notation for Y-RID. 9. 01/2012 2120C NM1 01 Entity Identifier Code For MCO or PCC: 2120C/NM101, changed value 13 to P3. -2- Commonwealth of Massachusetts Executive Office of Health and Human Services Changes to Companion Guides January 2012 276/277 Companion Guide Item Date Loop Segment Element Name Change 1. 10/2011 ---- BHT 03 Reference Identification Added segment. 2. 10/2011 ---- BHT 05 Time Added segment. 3. 12/2011 2100D NM1 04 Name First Corrected segment ID. 820 Companion Guide Item Date Loop Segment Element Name Change 1. 08/2011 Header BPR 01 Transaction Handling Code Added value U. 2. 08/2011 Header BPR 01 Transaction Handling Code Removed value I. 3. 08/2011 2300B DTM 01 Data Time Qualifier Added segment. 4. 10/2011 2000A 2200A ENT ADX Removed 2000A ENT and 2200A ADX for organizational summary. 834 Outbound Companion Guide Item Date Loop Segment Element Name Change 1. 08/2011 1000A N1 03 Identification Code Qualifier Removed code ZZ and added code FI. 2. 08/2011 2000 INS 03 Maintenance Type Code Removed code 025. 3. 08/2011 2000 INS 13 Confidentiality Code Added code U. 4. 08/2011 2000 REF 02 Reference Identification Added code DX. 5. 08/2011 2100A DMG 06 Date Time Period Format Qualifier Removed segment. 6. 08/2011 2100C NM1 01 Entity Identifier Code Removed code IL and added code 31. -3- Commonwealth of Massachusetts Executive Office of Health and Human Services Changes to Companion Guides January 2012 834 Outbound Companion Guide Item Date Loop Segment Element Name Change 7. 08/2011 2300 HD 01 Maintenance Type Code Removed codes 25 and 26. 8. 10/2011 ---- ST 01 Transaction Set Identifier Code Added segment. 9. 10/2011 ---- BGN 02 Reference Identification Added segment. 10. 10/2011 ---- BGN 05 Time Code Added segment. 11. 10/2011 2100 INS 08 Employment Status Code Removed code FT. 12. 10/2011 2100A DMG 01 Date Time Period Format Qualifier Added segment. 13. 10/2011 2100C NM1 02 Entity Type Qualifier Added segment. 14. 10/2011 2100G PER 01/03 /04 Contact Removed segments. 15. 10/2011 2100G N3 01/02 Responsible Party Removed segments. 16. 10/2011 2100G N4 01/02 /03 Responsible Party Removed segments. 17. 10/2011 2300 DTP 02 Date Format Qualifier Added segment. 18. 10/2011 2310 LX 01 Assigned Number Added segment. 19. 10/2011 2320 DTP 02 Date Format Qualifier Added segment. 20. 10/2011 2710 LX 01 Assigned Number Corrected segment (was shown as 2700 LX 01). 21. 12/2011 ----ISA 11 Repetition Separator Added segment. 22. 12/2011 ---- GS 02 Application Sender’s Code Added segment. 23. 12/2011 ---- GS 08 Version / Release / Industry Identifier Code Added segment. 24. 12/2011 2000 REF 01 Reference Identification Qualifier Removed code 17. 25. 12/2011 2100A LUI 02 Language Code Updated segment. 26. 12/2011 2100A LUI 03 Language Description Removed segment. 27. 12/2011 2100A LUI 04 Use of Language Indicator Added segment. 28. 12/2011 2300 DTP 01 Date Time Qualifier Removed code 349. 29. 12/2011 2310 NM1 03 Name Last Removed segment. 30. 12/2011 2310 NM1 04 Name First Removed segment. 31. 12/2011 2310 NM1 05 Name Middle Removed segment. 32. 12/2011 ---- SE 01 Number of Included Segments Added segment. -4- Commonwealth of Massachusetts Executive Office of Health and Human Services Changes to Companion Guides January 2012 834 Outbound Companion Guide Item Date Loop Segment Element Name Change 33. 12/2011 ---- SE 02 Transaction Set Control Number Added segment. 34. 12/2011 2300 DTP 01 Date Time Qualifier Added Note. This segment is not used to report the Assignment plan ends date. 35. 12/2011 2700 LX 01 Assigned number Corrected segment (was shown as 2710 LX 01). 835 Companion Guide Item Date Loop Segment Element Name Change 1. 08/2011 2100 AMT 01 Amount Qualifier Code Added value F5. 2. 08/2011 2100 CLP 02 Claim Status Code Removed values 5, 17, 19, 20, 21, 23, 25, and 27. 3. 08/2011 2100 CLP 02 Claim Status Code Revised descriptions for values 1, 2, 3, and 4. 4. 08/2011 2100 DTM 01/02 Coverage Expiration Date Added segment. 5. 08/2011 2100 DTM 01/02 Claim Date Deleted segment. 6. 08/2011 2100 NM1 Corrected Priority Payer Name Added segment. 7. 08/2011 2100 REF 01 Reference Identification Qualifier Removed value 1L. 8. 08/2011 2100 REF 01 Reference Identification Qualifier Added value 6P. -5- Commonwealth of Massachusetts Executive Office of Health and Human Services Changes to Companion Guides January 2012 837I Companion Guide Item Date Loop Segment Element Name Change 1. 07/2011 2300 HI 01-1 Patient’s Reason for Visit Per Implementation Guide, required when claim involves outpatient visits. 2. 10/2011 2410 LIN 02 Product or Service ID Qualifier Updated the definition for 2410/LIN02 to include the use of qualifier N4 before all NDC codes. 3. 12/2011 2300 NTE 01/02 Note Reference Code Description Updated code values. 837P Companion Guide Item Date Loop Segment Element Name Change 1. 07/2011 2400 SV1 03 Unit or Basis for Measurement Code Code MJ must be used for anesthesia services. Otherwise, use code UN. 2. 07/2011 2400 SV1 04 Quantity The maximum length for this field is eight digits, excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. 3. 10/2011 2420G 2420H Ambulance Pick-Up Location Ambulance Drop-Off Location Added note to 2420G and 2420H clarifying the situational use of ambulance pick-up and drop-off information. 4. 10/2011 2410 LIN 02 Product or Service ID Qualifier Updated the definition for 2410/LIN02 to include the use of qualifier N4 before all NDC codes. 5. 12/2011 2300 NTE 01/02 Note Reference Code Description Updated code values. -6-