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Last Modified: 11/8/2017 Location: FL, PR, USVI Business: Part A, Part B

HIPAA 5010 transaction edits: July 2017 update

Due to the Health Insurance Portability and Accountability Act (HIPAA), change request 9881, and electronic data interchange (EDI) front-end updates, the Centers for Medicare & Medicaid Services has implemented 5010 837P and 837I transaction edits, effective July 1, 2017.

Updated 5010 837P transaction edits -- effective July 1, 2017

Edit reference number

Change

X222.121.2010BA.NM109.020
Revised edit to include MBI format
X222.320.2330B.NM1.010
Per Payer added to Logic. Edit applies to each individual payer
X222.320.2330B.NM1.020
Per Payer added to Logic. Edit applies to each individual payer
X222.325.2330B.DTP.020
Per Payer added to Logic. Edit applies to each individual payer
X222.325.2330B.DTP.030
Per Payer added to Logic. Edit applies to each individual payer
X222.490.2430.DTP.010
Per Payer added to Logic. Edit applies to each individual payer
X222.490.2430.DTP.020
Per Payer added to Logic. Edit applies to each individual payer
X222.405.2400.REF.020
Added Description to edit line

Updated 5010 837I transaction edits -- effective July 1, 2017

Edit reference number

Change

X223.384.2330B.NM1.010
Revised 999R edit
X223.384.2330B.NM1.020
Revised 999R edit
X223.389.2330B.DTP.020
Revised 999R edit
X223.389.2330B.DTP.030
Revised 999R edit
X223.112.2010BA.NM109.020
Added edit for MBI/HICN claim effective date
X223.189.2300.HI02-2.025
If 2300.HI02-1 = "APR", then 2300.HI02-2 must not begin with a "V", "W", "X" or "Y"
X223.189.2300.HI03-2.025
If 2300.HI03-1 = "APR", then 2300.HI03-2 must not begin with a "V", "W", "X" or "Y"

Added 5010 837P transaction edits -- effective July 1, 2017

Edit reference number

Change

X222.121.2010BA.NM109.030
Added new edit for MBI/HICN effective date
X222.197.2300.REF02.070
Added new CLIA edit
X222.404.2400.REF02.070
Added new CLIA edit
X222.405.2400.REF02.070
Added new CLIA edit

Added 5010 837I transaction edits -- effective July 1, 2017

Edit reference number

Change

X223.112.2010BA.NM109.040
Added edit for MBI/HICN claim effective date
X223.189.2300.HI01-1.040
Added edit for Patient Reason for Visit Code (CR9808)
X223.150.2300.DTP03.040
Added edit for MBI/HICN for IP claims with a from date prior to the end of the new Medicare cards transition period

Updated 5010 276 transaction edits -- effective July 1, 2017

Edit reference number

Change

X212.56/135.2100D.NM109.020
Revised edit to include MBI format.

Deactivated 5010 276 transaction edits -- effective July 1, 2017

Edit reference number

Change

X212.49/126.2100C.NM104.020
Edit deactivated
Source: CR 9881
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