April 2015 ASC X12 837 (electronic healthcare claim) -- CMS edits implementation

Due to the Health Insurance Portability and Accountability Act (HIPAA), change request 8851, and electronic data interchange (EDI), front-end updates, the Centers for Medicare & Medicaid Services has implemented 5010 837P and 837I transaction edits, which will be effective: April 6, 2015.

Added 5010 837P transaction edits -- effective April 6, 2015

Edit Reference number	Change
X222.226.2300.HI01-2.130	277CA edit added to reject claims if the diagnosis code is duplicated within the HI segment
X222.242.2300.HI01-2.030	277CA edit added to reject claims if the Condition codes are duplicated within the HI segment
X222.351.2400.SV101-3.030	277CA edit added to reject claims if the Modifier codes are duplicated within the same SV1 segment
X222.480.2430.SVD03-3.020	277CA edit added to reject claims if the Modifier codes are duplicated within the same SVD segment
Added 5010 837I transaction edits -- effective April 6, 2015
Edit Reference	Change
X223.189.2300.HI01-2.050	277CA edit added to reject claims if the Patient Reason for Visit Code in the HI segment is duplicated
X223.193.2300.HI01-2.060	277CA edit added to reject claims if the External Cause of Injury Code in the HI segment is duplicated
X223.220.2300.HI01-2.050	277CA edit added to reject claims if the Diagnosis Code in the HI segment is duplicated
X223.294.2300.HI01-2.020	277CA edit added to reject claims if the Condition Code in the HI segment is duplicated
X223.424.2400.SV202-3.020	277CA edit added to reject claims if the Procedure Code Modifier in SV202 within the same detail service line is duplicated.
X223.476.2430.SVD03-3.020	277CA edit added to reject claims if the Modifier codes are duplicated within the same SVD segment
X223.304.2300.HI02.020	edit added to ensure treatment codes are not duplicated
Updated 5010 837I transaction edits -- effective April 6, 2015
Edit Reference	Change
X223.184.2300.HI.013	revised
X223.184.2300.HI.016	revised
X223.366.2320.AMT.020	999 edit revised to only allow one iteration of the loop/segment.
X223.367.2320.OI.020	999 edit revised to only allow one iteration of the loop/segment.
X223.369.2320.MIA.020	999 edit revised to only allow one iteration of the loop/segment.
X223.374.2320.MOA.020	999 edit revised to only allow one iteration of the loop/segment.
X223.377.2330A.NM1.020	999 edit revised to only allow one iteration of the loop/segment.
X223.380.2330A.N3.020	999 edit revised to only allow one iteration of the loop/segment.
X223A2.21.2330A.N4.020	999 edit revised to only allow one iteration of the loop/segment.
X223.384.2330B.NM1.020	999 edit revised to only allow one iteration of the loop/segment.
X223.386.2330B.N3.020	999 edit revised to only allow one iteration of the loop/segment.
X223A2.22.2330B.N4.020	999 edit revised to only allow one iteration of the loop/segment.
X223.389.2330B.DTP.020	999 edit revised to only allow one iteration of the loop/segment.
X223.392.2330B.REF.020	999 edit revised to only allow one iteration of the loop/segment.
X223.393.2330B.REF.020	999 edit revised to only allow one iteration of the loop/segment.
X223.394.2330B.REF.020	999 edit revised to only allow one iteration of the loop/segment.
X223.395.2330B.REF.020	999 edit revised to only allow one iteration of the loop/segment.
X223.476.2430.SVD.010	999 edit revised to only allow one iteration of the loop/segment.
X223.486.2430.DTP.020	999 edit revised to only allow one iteration of the loop/segment.
X223.487.2430.AMT.020	999 edit revised to only allow one iteration of the loop/segment.
X223.184.2300.HI.014	revised comment to: Only ICD-9 qualifiers are allowed on production claims prior to the effective date of ICD-10.  The purpose of this edit is to prevent ICD-10 codes from coming into the system on production claims prior to ICD-10 being in effect.
X223.239.2300.HI01-1.011	revised comment to: Only ICD-9 qualifiers are allowed on production claims prior to the effective date of ICD-10.  The purpose of this edit is to prevent ICD-10 codes from coming into the system on production claims prior to ICD-10 being in effect.
Deactivated 5010 837I transaction edits -- effective April 6, 2015
Edit Reference	Change
X223.354.2320.SBR.010	edit deactivated
X223.239.2300.HI01-1.013	deactivated
X223.239.2300.HI01-1.016	deactivated