X12N TGB WG2 Billing and Encounter Information January-February 2014 Refer to Scheduled Meetings Table for Call in Information

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1 ASC X12N TGB WG2 JanFeb X12N TGB WG2 Billing and Encounter Information January-February Refer to Scheduled Meetings Table for Call in Information Group Leadership Chair Name Company Term End Phone Date Jamie Mosteller Siemens June (Claims) Gloria Davis (Claims) Healthcare QSI/NextGen Healthcare Information System January Chris Cioffi Wellpoint, Inc. June (Attachments) Karen Shutt Highmark, Inc. June (Claims Status) Secretary Name Company Term End Phone Date Cindy Monarch BCBS of Michigan Katie Sullivan Cognosante Quorum Requirement Statement This group enforces quorum requirements for group voting items. This group does not enforce quorum requirements for group voting items. X Work Products and Status (e.g. Transaction Sets Implementation Guides, etc.) Work Product Name Work Product Status Work Product ID # (opt) Health Care Claim: Professional Published X259 (006020) Health Care Claim: Institutional Published X260 (006020) Health Care Claim: Dental Published X261 (006020) Health Care Claim: Data Reporting Published X262 (006020) Health Care Predetermination of Benefits Published (Professional) Health Care Predetermination of Benefits Published (Institutional) Additional Information to support a Published X275 (006020) Health Care Claim or Encounter 277 Request for Additional Information Published X268 (006020) 276/277 Claim Status Inquiry and Published X267 (006020) Response 277 Health Care Claim Published X269 (006020) Acknowledgement 277 Health Care Claim Pending Status Information Published X270 (006020) Revised 9/2013 Page 1 of 5

2 ASC X12N TGB WG2 JanFeb Scheduled Meetings Type of Meeting Date Location/Cal l in Current Meeting - CLAIMS Next Standing Meeting Interim Meeting CLAIMS 1/9/ ; AC: # January 26-30, 2 nd and 4 th Thursday 1 2:30 pm Eastern Birmingham, AL ; AC: # Contact Gloria Davis or Jamie Mosteller Co-Chairs Gloria Davis or Jamie Mosteller Agenda RFI Review BRTS Review CRs General Discussion Items Voting Items DSMO DMs CRs/Guide work BRTS DSMO CRs/Guide work BRTS Key Discussion Item Attendance = 15 Discussion Reviewed Agenda for Standing Meeting (will meet as the entire group) RFI 1886 Requests using the K3 for reporting of NDC so the repackaged NDC as well as the original ND can both be reported on the claim o Does there need to be a DSMO for a permanent solution or is a CR sufficient? Need to be careful not to approve the K3, but later disapprove a DSMO Workgroup needs to understand the process regarding adding a permanent solution and how it ties to the K3 segment o What is the business rule for sending this information? o Think we need look at further, need to understand the process and perhaps discuss further in Birmingham. o IAIABC has a companion guide and the annual publication of this document is February 1 st, so we are looking at obtaining approval prior to that time o ACTION: Mark C to Gail K and Kelly B to determine the exact process. Add to Standing Meeting Agenda Monday CR 1349 All claim guides, requests modifying the situational rule for the referral number to allow for its use to a specific service line without a requirement for one to be reported at the claim level o The 5010 had a TR3 note to explain how this could be accomplished, but the TR3 note is not in the 6020 o Note: the TR3 note as written in the 5010 refers to the REF01 as being the same, however it should be the REF02 o Claims accepts the business requirement and will need a BRTS. ACTION: Add to list of change requests to be worked on at next standing meeting CR 1351 To remove the Patient Estimated Amount Due, this will align with the UB manual o Claims accepts the business requirement and will need a BRTS. ACTION: Add to list of change requests to be worked on at next standing meeting CR 1359 Sales taxes have been removed from the 837P and 837D, because there are now both HCPCS and CDT Revised 9/2013 Page 2 of 5

3 ASC X12N TGB WG2 JanFeb codes to cover the sales tax. There are other taxes that need to be reported on the claim. o Minnesota needs a location for reporting state specific taxes Provider tax Other states also these, but it isn t clear as to whether it is the same and whether other states have another way of gathering this information Need to add a other tax (possibly Provider Tax) segment structured in a similar fashion to the recently removed sales tax o Claims Accepts the Business and a BRTS is needed. Will be added to the list of CRs to work on at standing meeting. ALL CLAIMS (I, P, D) Reviewed current Change Request Spreadsheet CR DM to add OI segment for provider accept assignment (OI05 needs to be added to the other payer so it can be maintained throughout COB). CR Expand business terminology to such as factoring agent, redetermination and should include examples. Not a harmonization issue as they only handle items across all guides. ACTION: Mark to follow-up with Chip and look at front matter bringing possible examples to standing meeting CR CN1 on post adjudicated claims. The situational rule for the elements may be incorrect and require updating. Decisions See above Scheduled Meetings Type of Meeting Date Location/Cal l in Current Meeting - 2/13/ ; AC: Next Standing Meeting Interim Meeting - June 1-5, 2 nd and 4 th Thursday 1 2:30 pm Eastern # New Orleans, LA ; AC: # Contact Co-Chairs Co-Chairs Co-Chairs Agenda BRTS Review CRs General Discussion Items Voting Items DSMO DMs CRs/Guide work BRTS DSMO CRs/Guide work BRTS Key Discussion Item Attendance = 23 Discussion RFI Review 1892 Gloria reviewed RFI and draft response. Doug indicated while it has come up in past in WG2, no business need has ever been brought forward. A comment will be added to the response that no business need has ever Revised 9/2013 Page 3 of 5

4 been identified so far. ASC X12N TGB WG2 JanFeb Gloria reviewed RFI and draft response. WG agrees with proposed response, but requested the following also be added to the response: The total charge would be reported in SV203. New CRs R F REFERRING PROVIDER NAME - TR3 note is wrong, (Loop 2420 doesn't exist) Gloria reviewed CR. 837 TR3 note has invalid reference to Martin Wilbanks agreed to draft the BRTS Allow Prior Authorization number to be reported at the line regardless if it has been reported at the claim level CR generated out of standing meeting. Gloria reviewed CR info with WG. BR should mimic CR 1349 for what the WG did with referrals, but this is for Authorization number. Rose Hodges volunteered to draft the BRTS. Open CRs Evaluate REF segments with State License Number Skipping Tina Greene could not be on the call for discussion Move Insurance Type Codes (EB04) as an External Code List Gloria reviewed basic concept of BRTS (WG1 wants to move Insurance Type Codes to external list). Also reviewed comments posted so far on CD space. Doug we use it for Medicare secondary reporting (SBR05) This needs to stay in guide. Annie Feels this is confusing as to why the payers even need this data. Gloria/Doug This is used for editing, validating data on inbound claim per product type. Confusion as to why we are not all using the same element and or at least the same code source (944 Payment of Typology Code) WG2 feels the 270/271 needs to also use the 944 Code Source so that we are all using the same values. We may need to have harmonization helps us with coordination. We will go back to WG1 on the BRTS with our concerns. TGB Management sent stating: WG2 is assigned as the primary WG for the below change request that were submitted after the cutoff date for the next version. WG reviewed the list and responded below: 1334 Removing the sales tax from Dental guide now follows both the 837I and 837P guides. BRTS has been submitted 1343 This is necessary so that we do not have to continue the usage of the K3 in the next guide. BRTS has been submitted 1349 This is necessary for consistency of using the referral and referring provider claim vs line level. BRTS has been submitted 1351 This is necessary as the Patient Estimated Due AMT is no longer used in the UB Manual. BRTS has been submitted 1359 DM was completed this is to add to the 837 guides. BRTS has been submitted 1390 Found this error in reviewing changes for CR1349. BRTS is in progress 1392 With changes for CR1349 for Referral need to have the authorizations follow the same. BRTS is in progress Revised 9/2013 Page 4 of 5

5 ASC X12N TGB WG2 JanFeb Decisions o See above Revised 9/2013 Page 5 of 5

6 Aileen Belen Aimee Y. Thatcher Kaiser Permanente Magellan Behavioral Health Claims Billing & Encounters Annie Brannan Mayo Foundation X X B. Annette Atherton ZirMed, Inc. Barb R. Keiley Beth Ortega Betsy B. Clore Bob Ferguson Bobbett Plummer Brent Hall Brian Flynn Brian G. Dodge Brigid Noonan Premera Blue Cross HP Wake Forest University Health Sciences Clinitech Information Resources CMS/HHS Blue Cross Blue Shield Associations National Association of Dental Plans Health Management Systems Gateway EDI, Inc. Cameron Gunderson Utah Health Information Network X Carolyn Besch United Health Group X Carolyn Midkift Catherine M. Luett Florida Blue Cathy Brock Blue Cross Blue Shield of Minnesota X Chanelle Jones Cheryl Kelly Cheryl Parkins Cheryl Tichonevicz Chris Cioffi Chris H. Augustine Christina Orlando CMS State of Arizona - AHCCCS Clinitech Information Resources Highmark, Inc. Wellpoint, Inc. Highmark, Inc. Health Care Service Corporation

7 Christine Doyle, M.D. American Society of Anesthesiologists Christol Green Wellpoint, Inc. X Christopher Hahn Christopher J Gracon Christy Walt Cindy Monarch Clarissa Winchester Claudette Campbell Claudette Sikora Cynthia Fiore Darlene Gandara Dave Spring David A. Feinberg David Bennett David Clark David Coomer VIPS, Inc. Independent Health Central Washington Hospital BCBS Michigan BCBS Alabama Premera Blue Cross CMS/HHS United Health Group Kaiser Permanente Illinois Medicaid (Department Of Public Aid) Rensis Corp. State Farm Insurance Companies American Family Insurance David Haugen Minnesota State X X David Wilderman Dean Cook Debbie Hagan Debbie McCachern Debbie Meisner Debbie Taylor Deborah Jackson-Johnson Denise Thompson Desireee Van Lieu Diana Harvie Dept of Defense MHS/TriCare National Government Services Florida Blue Emdeon Emdeon Health Care Service Corporation (HCSC) Florida Blue Pinnacle Business Solutions, Inc IBM

8 Dominick DiMaggio Don Fleishman Donald D. Holmes Donna Campbell Florida Blue Delance Corporation Delta Dental of California Doreen Lance Florida Blue X Douglas Renshaw Highmark, Inc. X X Duane Collins Duane Walker Durwin Day Edward Yuabov Eileen Mackey Elizabeth A. Buckley Elizabeth Templeton BCBS of Alabama Blue Cross Blue Shield of Michigan Health Care Service Corporation (HCSC) Montefiore Medical Center Metlife HP First Coast Service Options, Inc. Eric Kirnbauer Tesia Clearinghouse, LLC X Erick Puro Erin Richter Weber Erwin Medina Deloitte/MHS CAQH/CORE Florida Blue Fred Rooke CMS X Ganesh Ramu Gary Moon Gayle Dooley Gema Medina Gigi Mendenhall Gladys L. Jones MZI Health Care Professional HealthCare Support Services Corporation (PHSSC) Aetna Inc. Health Care Service Corporation (HCSC) HP Group Health Cooperative Gloria Davis QSI/NextGen Healthcare Information System X X Harold Smith James Byers North Carolina Division of Medical Assistance Emdeon

9 James Mosteller SIEMENS Medical Solutions X Jana White Jane Depeaux Janice Bakos Jason Jackson Jean Narcisi Jeanie Smith Jeanne Kirkpatrick Jeff Gustafson Jerry L. Brown Jill Money TrailBlazer Health Enterprises, LLC Horizon Blue Cross Blue Shield of NJ Aetna Inc. CMS/HHS American Dental Association Blue Cross and Blue Shield of Florida Blue Cross Blue Shield of Michigan Gateway EDI, Inc. Health Management Systems Blue Cross Blue Shield of Mi Jim McKinley Blue Cross and Blue Shield of Alabama Jim Whicker Workgroup for Electronic Data Interchange (WEDI) X Jim Whicker Jimmy Terrapin Jo Steinert Kaiser Permanente/AAHAM Blue Cross Blue Shield of South Carolina Ohio Medicaid JoAnne M. Weingarth Wellpoint, Inc. Jodie Banks RelayHealth X X John Bock John Rowell Joyce Cianciola Judith Pasick Julia Dunicheva Julia Sakhnov Independent Member Wellfare Pension & Administration Services (WPAS, Inc) Wellpoint, Inc. Metlife Edifecs Inc. Edifecs Inc. Julie Jensen Cerner Julie Payne Health Technologies X Karen Shutt Highmark, Inc. X X

10 Katherine Sullivan Cognosante, LLC X Kathy A. Leahy Kathy Cool Kathy A. Leahy Kathy Ochal Kelly Butler Kena Gwinn Kirk Boaz Kristin Delfino Ladean Palodichuk Larry Shorey Laura Caldwell Laurie Burckhardt Laurie Darst Laurie Woodrome Linda Williamson Lisa Munn Lisa Savicki Lori McLaughlin Lynn F. Chapple Lynn Cleckler Premera Blue Cross CIGNA/Sagamore Health Netowrk Premera Blue Cross SIEMENS Medical Solutions Emdeon, LLC Wellpoint, Inc. State Farm Insurance Companies State of Alaska, Department of Health and Social Services Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of South Carolina CSC WPS Insurance Corp. Mayo Foundation Laboratory Corporation Of America Aetna Inc. Cerner Corporation Wellpoint, Inc. UnitedHealth Group BCBS Alabama Marc Leib, M.D., J.D. American Society of Anesthesiologists Mark Carter State Farm Insurance Companies X X Martin C. Wilbanks U.S. Department of Veterans Affairs X Mary Helm Mary Kay McDaniel Mary Tyra HPES Cognosante, LLC Depart of VA-Health Administration Center

11 Matthew A. Klischer Meledie Meyer Melissa Wright Michael Nichols Michele Davidson Mike Parrish Minil Mikkili Myra Reinhardt CMS/HHS WPS Insurance Corp. Blue Cross Blue Shield of SC Pharmacist Collaborative Delta Dental of Virginia Kaiser Permanenti TransUnion Nancy W. Spector American Medical Association X Pamela M. Davis Pat Edmondson Pat VanDyke Pat Wijtyk Patrick Cannady Patrick McLaurin Peter Strand Phil Martinez System Designs, Inc. ODS WPC - Services American Dental Association Mitchell International Valence Health, Inc. Mitchell International Philip L. Evelsizer State Farm Insurance Companies X X Rachel Foerster Rachelle Caldwell Council for Affordable Quality Healthcare Illinois Medicaid (Department Of Public Aid) Raymond Sevier State Farm Insurance Companies X Rebecca Fortek Mayo Foundation X X Reza Nouraei Rini Jose Robert A. Davis Robert Poiesz Ron Story EDI Health Group, Inc. MZI Health Care Robert Davis, I.M. American Medical Association Delta Dental of Michigan, Ohio & Indiana

12 Rose Hodges Aetna Inc. X Shannon Hughes Sharon Owens Stacey Bickford Steve Cloutier Stewart Presser Sue Thompson HFS-Illinois U.S. Department of Veterans Affairs Zoll Blue Cross Blue Shield of Michigan GNYHA NCPDP Sue Ulman Cerner Tammara Jean Paul National Center for Health Statistics (CDC) X Teresa Hiltenbrand Theresa Jansen Tim King Timothy L. Brown Passport Health United Concordia Companies Inc. National Association of Dental Plans Timothy W Morgan United Health Group Tina Greene Mitchell WCS X Todd Omundson American Hospital Association X Tom E. Drinkard DDVA Tony Benson Blue Cross Blue Shield of Alabama X X Valerie Jackson Vasu Kakollu Wendy Slater Yvonne Young ODTFS Ohio Medicaid Total Attendance: 15 23

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