clm104c31.pdf

Under HIPAA, all payers must use health care claim status category codes and health care claim status codes approved by the Health Care Code Maintenance Committee as applicable.  At each ASC X 12 trimester meeting (generally held the months of February, June and October), the Committee may update the claim status category codes and the claim status codes.  When instructed, Medicare contractors must update their claims systems to assure that the current version of these codes is used in their claim status responses.  The codes sets are available at the official Washington Publishing Company website .  Included in the code lists are specific details, including the date when a code was added, changed  or deleted.   CMS will issue recurring, one -time change requests regarding the need for and deadline for future updates to these codes.  Contractor and shared system changes will be made as necessary as part of a routine release to reflect applicable chang es such as retirement of previously used codes or newly created codes that may impact Medicare.  Shortly after the release of each code update, a provider education article will be available at http://www.cms.hhs.gov/medlearn/matters  for contractors to use to conduct provider outreach.   Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R10236CP   07/31/2020  Update to the IOM Publication (Pub) 100-04, Medicare Claims Processing Manual, Chapters 1, 6, 8, 17, 20, 22, 24, and 31 Referencing the Active Universal Resource Locators (URLs) for the Washington Publishing Company (WPC) and the ASC X12 Organizations, and Updates to the HIPAA Eligibility Transaction System (HETS)  08/31/2020  11857  R4388CP  09/06/2019  Manual Updates to Chapters 1, 22, 24, 26, and 31 in Publication (Pub.) 100 -04 10/07/2019  11331  R4260CP  03/22/2019  Update to Chapter 31 in Publication (Pub.) 100-04 to Provide Language -Only Change s for the New Medicare Card Project  04/22/2019  11178  R2937CP  04/25/2014  Medicare Claims Processing Pub. 100- 04 Chapter 31 Update  04/14/2014  8640 R2909CP  0314/2014 Medicare Claims Processing Pub. 100- 04 Chapter 31 Update  Rescinded and replaced by Transmittal 2937  04/14/2014  8640 R2165CP  02/25/2011  Update for Pub. 100- 04. Medicare Claims Processing Manual, Chapter 31 03/25/2011  7245 R1149CP  01/05/2007  Revision of Chapter 31 Eligibility Rules of Behavior  04/02/2007  5431 R991CP  06/23/2006  Eligibility Rules of Behavior  07/24/2006  5138 R892CP  03/24/2006  Eligibility Transaction URL Update  06/26/2006  4366 R793CP  12/29/2005  Revision to Chapter 31- Addition of Hospice Data HIPAA270/271 Eligibility  01/23/2006  4193 R791CP  12/23/2005  Revision to Chapter 31- Addition of Hospice Data HIPAA270/271 Eligibility  01/23/2006  4193 R583CP  06/15/2005  Access Process for HIPAA 270/271 (Extranet Only)  08/22/2005  3883 Rev #  Issue Date  Subject  Impl Date  CR#  R565CP  05/20/2005  Access Process for HIPAA 270/271 (Extranet Only)  08/22/2005  3883 R490CP  03/04/2005  Claims Status Code/Claim Status Category Code Update  07/05/2005  3715 R406CP  12/17/2004  Update to Health Care Claims Status Category Codes and Health Care Claim Status  Codes for Use with the Health Care Claim Status Request and Response ASC X12N 276/277. 04/04/2005  3566 R230CP  07/23/2004  Update to Health Care Claims Status Category Codes and Health Care Claim Status Codes for Use with the Health Care Claim Status Request and Response (ASC X12N 276/277)  01/03/2005  3361 R096CP  02/06/2004  Health Care Claims Status Category Codes and Health Care Claim Status Codes for Use with the Health Care Claim Status Request and Response (ASC X12N 276/277)  N/A 3017 R001CP  10/01/2003  Initial Publication of Manual  NA NA Back to top of chapter