HIPAA: 837 Version 4010A1 Transaction - Correction of Systems Errors
January 14, 2004Errors that occurred during the processing of 837 Version 4010A1 transactions submitted between September 22, 2003 and January 12, 2004 have been corrected. Descriptions of the errors are as follows:
- Discharge Date: When the discharge date and the Thru Statement Period Date on a final transaction are the same, the discharge date does not need to be submitted with occurrence code 42; the discharge date is assumed to be the Thru Statement Period Date. Providers correctly submitted the discharge date on inpatient 837 transactions without occurrence code 42. However, they erroneously received Resubmission Turnaround Documents (RTDs) for error codes 122 (discharge date missing, invalid or less than thru date) and 124 (patient status blank, invalid or inconsistent with discharge date).
- Surgery Date: Providers correctly billed qualifier “BR” (ICD-9-CM Principal Procedure) with a surgery date on inpatient 837 transactions but erroneously received RTDs for error code 100 (date of surgery/delivery missing or invalid).
- Multiple Providers: Providers correctly indicated more than one non-billing provider (such as a rendering, referring, operating or facility provider) in the 2300 or 2400 loop of medical, outpatient and inpatient 837 transactions, but unreliable translation occurred.
All systems issues responsible for the errors have been resolved. Inpatient 837 transactions have been corrected. Outpatient and medical 837 transactions will be corrected by January 24, 2004. The Provider Telecommunications Network (PTN) will reflect a status for corrected 837 transactions on or before January 24, 2004. Because these were systems errors, providers should not change their 837 transaction billing practices.
Note: Affected 837 transactions submitted on or after January 13, 2004 could still generate RTDs for reasons unrelated to the above errors. Providers must return such RTDs with corrections before transaction processing can continue.During the review of affected 837 transactions, the following billing errors were identified on numerous inpatient transactions:
- The AMT01 and AMT02 segments in position 175 of the 2300 loop (Estimated Claim Due Amount [Net Amount Billed]) were missing, generating an RTD for error code 042 (net amount billed missing or invalid). These segments are required, and these transactions must be resubmitted with the missing segments. Refer to the Inpatient Services HIPAA ASC X12N Companion Guide for more information. Note: This error has been observed during media activation testing and in production. The amounts in the AMT02 segment are reflected on Computer Media Claims (CMC) test and production reports available to submitters. Values of zero on these reports are the result of no data in the AMT02 segment.
- The subscriber date of birth and gender code were mistakenly submitted in the 2000C loop, generating an RTD for error codes 003 (sex code missing or invalid) and 0116 (date of birth missing or invalid). Medi-Cal does not use the 2000C loop. This data must be transmitted in the 2000B loop in segments DMG02 and DMG03, respectively. For Medi-Cal, the subscriber is always the recipient. Refer to the Inpatient Services HIPAA ASC X12N Companion Guide for more information. Medi-Cal is correcting this billing error on inpatient 837 transactions submitted through January 12, 2004. Transactions submitted on or after January 13, 2004 that contain these DMG segments in the 2000C loop will generate an RTD.
Note:
If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.