**HIPAA Business Transactions & Code Sets**

**In Relation to RPMS Applications and Patches**

+----------+-------------------------------+---------------------------+
| **x.12   | **Transaction Standard**      | **RPMS Application**      |
| St       |                               |                           |
| andard** |                               | **Version/ Patch**        |
+----------+-------------------------------+---------------------------+
| **270**  | Eligibility Inquiry           | Pt Registration v7.0      |
+----------+-------------------------------+---------------------------+
| **271**  | Eligibility Reply             | Pt Registration v7.0      |
+----------+-------------------------------+---------------------------+
|          | Generic Interface Software    | GIS v3.01 (Required)      |
|          | (GIS)                         |                           |
+----------+-------------------------------+---------------------------+
|          |                               |                           |
+----------+-------------------------------+---------------------------+
| *        | Pharmacy Claim                | Pharmacy v5.1 POS v1.0p2  |
| *NCPDP** |                               |                           |
+----------+-------------------------------+---------------------------+
| **837**  | Claim Request, Institutional  | 3^rd^ Party Billing, v2.5 |
|          |                               | p3                        |
+----------+-------------------------------+---------------------------+
| **837**  | Claim Request, Professional   | 3^rd^ Party Billing, v2.5 |
|          |                               | p3                        |
+----------+-------------------------------+---------------------------+
| **837**  | Claim Request, Dental         | 3^rd^ Party Billing, v2.5 |
|          |                               | p3                        |
+----------+-------------------------------+---------------------------+
|          | Generic Interface Software    | GIS v3.01 p5 (Optional)   |
|          | (GIS)                         |                           |
+----------+-------------------------------+---------------------------+
|          |                               |                           |
+----------+-------------------------------+---------------------------+
| **835**  | Claim Reply, (Remittance      | Accounts Receivable, v1.7 |
|          | Advice)                       |                           |
+----------+-------------------------------+---------------------------+
|          | Generic Interface Software    | GIS v3.01 p6 (Required)   |
|          | (GIS)                         |                           |
+----------+-------------------------------+---------------------------+
|          |                               |                           |
+----------+-------------------------------+---------------------------+
| **276**  | Claim Status Request          | Accounts Receivable, v1.7 |
+----------+-------------------------------+---------------------------+
|          | Generic Interface Software    | GIS v3.01 p7 (Required)   |
|          | (GIS)                         |                           |
+----------+-------------------------------+---------------------------+
| **277**  | Claim Status Reply            | Accounts Receivable, v1.7 |
+----------+-------------------------------+---------------------------+
|          | Generic Interface Software    | GIS v3.01 p8 (Required)   |
|          | (GIS)                         |                           |
+----------+-------------------------------+---------------------------+
|          |                               |                           |
+----------+-------------------------------+---------------------------+
| **278**  | CHS Referral                  | Contract Health Serv,     |
|          |                               | v3.1 p5                   |
+----------+-------------------------------+---------------------------+
|          | Generic Interface Software    | GIS v3.01 p9 (Required)   |
|          | (GIS)                         |                           |
+----------+-------------------------------+---------------------------+
|          |                               |                           |
+----------+-------------------------------+---------------------------+
| **834**  | Enrollment/Disenrollment      | Under development         |
+----------+-------------------------------+---------------------------+
|          | Generic Interface Software    | GIS v3.01 p\_\_ (Under    |
|          | (GIS)                         | development)              |
+----------+-------------------------------+---------------------------+
|          |                               |                           |
+----------+-------------------------------+---------------------------+
| **820**  | Premium Payment               | Not applicable to RPMS    |
|          |                               | Business Applications     |
+----------+-------------------------------+---------------------------+

**HIPAA Standard Code Sets**

+----------------------------------------+-----------------------------+
| ## Standard Code Sets                  | ## RPMS Application Version |
+----------------------------------------+-----------------------------+
| # 2002 ICD 9 Codes                     | # AUM ICD Updates, v03.1    |
+----------------------------------------+-----------------------------+
| **2002 CPT Codes**                     | **CPT Updates**             |
+----------------------------------------+-----------------------------+
| **Standard Adjustment/Reason Codes**   | **Accounts Receivable, v1.6 |
|                                        | p3**                        |
+----------------------------------------+-----------------------------+
| **NDC**                                | **Pharmacy AWP monthly      |
|                                        | release**                   |
+----------------------------------------+-----------------------------+