HIPAA: Internet Professional Claim Submission (IPCS) Online Claim Form and User Guide Updates
July 17, 2004The 837 Professional Standard Claim on the Internet (also known as the Internet Professional Claim Submission [IPCS] Online Claim Form) is being updated to ensure compliance with HIPAA, with changes scheduled to be implemented at the end of July. The online claim form will be updated to include eight new fields: six on the Claim Info tab and two on the Service Details tab. In addition, 11 fields will be renamed: three on the Claim Info tab, three on the Subscriber Info tab (formerly named Recipient Info) and five on the Service Details tab. There are no changes to the Provider tab or to the way providers access the transaction on the Medi-Cal Web site. The Internet Professional Claim Submission (IPCS) User Guide will be updated to reflect these changes. The tables below summarize the new and renamed fields.
New Fields
Tab Name |
New Field Name |
Field Notes |
Claim Info |
Accident Date |
Onset of Current Illness/Accident Date field split into two separate fields. |
Claim Info |
Related Causes Code 2 |
An additional Related Causes Code field. |
Claim Info |
Related Causes Code 3 |
An additional Related Causes Code field. |
Claim Info |
Auto Accident State/ |
Active only if a Related Causes Code indicates an auto accident. |
Claim Info |
Country Code |
Active only if a Related Causes Code indicates an auto accident and Auto Accident State/Province Code is not in the United States. |
Claim Info |
File Information |
Optional field. Only required if legislatively mandated data have been requested by Medi-Cal to complete this claim. |
Service Details |
EPSDT Indicator |
EPSDT/Family Planning field split into two separate fields. |
Service Details |
Line File Information |
Optional field. Only required if legislatively mandated data have been requested by Medi-Cal to complete this claim. |
Renamed Fields
Tab Name |
Old Field Name |
New Field Name |
Subscriber Info |
Medi-Cal ID # |
Subscriber ID # |
Subscriber Info |
Date of Birth |
Subscriber Birth Date |
Subscriber Info |
Date of Issue |
Issue Date |
Claim Info |
Onset of Current Illness/Accident Date |
Onset of Current Illness/Injury Date |
Claim Info |
Related Causes Code |
Related Causes Code 1 |
Claim Info |
Remarks |
Claim Note Text |
Service Details |
EPSDT/Family Planning |
Family Planning Indicator |
Service Details |
From Date of Service |
From Service Date |
Service Details |
To Date of Service |
To Service Date |
Service Details |
Line Remarks |
Line Note Text |
Service Details |
Date of Onset |
Onset Date |
The following screens illustrate the new tabs of the IPCS Online Claim Form. New fields are circled in green. Renamed fields are circled in red. Hover your pointer over a new or renamed field in the screen examples below for information about the field.
Example 1: Subscriber Info Tab
(formerly named Recipient Info)
Example
2: Claim Info Tab
Example
3: Service Details Tab
Note:
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