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Elizabeth M. Whitehorn, Director

Provider Notice issued 08/08/07

Changes to Value Codes Denoting Coinsurance and Deductible for Electronic Claims

 

To:​

Participating Hospitals – Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities​
Date:​ August 8, 2007​
Re:​ Changes to Value Codes Denoting Coinsurance and Deductible for Electronic Claims​

 

The purpose of this notice is to advise hospitals and renal dialysis facilities of changes to the Value Code entries reported on electronic claim submissions.
 
The National Uniform Billing Committee (NUBC) has restricted the use of Value Codes A1, A2, A7, B1, B2, B7, C1, C2, and C7 to paper claims.  Effective with dates of service on or after July 1, 2007, these Value Codes will no longer be available for use on the X12N 837 Institutional claim transaction.

 

Currently, Value Codes for coinsurance and deductible are reported in Loop 2300, HI segment, qualifier “BE” of the 837I.  Effective with dates of service on or after July 1, 2007, coinsurance and deductibles will be reported in Loop 2320, CAS segment, Claim Adjustment Group Code “Patient Responsibility” (PR).  The following Reason Codes will be used to report coinsurance and deductible amounts:

 

1 = Deductible
2 = Coinsurance

 

Changes are in process to revise the Medical Electronic Data Interchange, Internet Electronic Claims (MEDI IEC) system to accommodate the new coding format.  At the time the new fields are implemented, providers should follow the revised MEDI IEC instructions for billing compliancy.  The MEDI homepage is located at:  http://www.myhfs.illinois.gov/

 

Again, this change in Value Codes only affects electronic claim submissions.  Billing for all other Value Codes remains the same.
 
This information should be shared with your billing services, software vendors and clearinghouses to ensure that your claims are processed appropriately.

 

Any questions regarding this notice may be directed to the provider’s UB billing consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

Theresa A. Eagleson, Administrator
Division of Medical Programs