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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/14/11

 837 Institutional 5010 Changes for Billing Covered and Non-Covered Days

To:​ Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities​
Date:​ ​December 14, 2011
​Re:  837 Institutional 5010 Changes for Billing Covered and Non-Covered Days​

Value Codes 80 and 81 have been required on the UB-04 paper claim format to report covered and non-covered days, but have not been required on electronic claim submittals based on the HIPAA 837I version 4010 guidelines. For electronic 4010 claims, the covered and non-covered days were reported using the QTY – Claim Quantity segment of Loop 2300. This segment is no longer available with HIPAA 837I version 5010.

Implementation of the 837I version 5010 is effective with claims received on or after January 1, 2012. With the implementation of the 837I version 5010, providers will be required to report Value Code 80 to denote covered days and Value Code 81 to denote non-covered days. These elements will be reported in the HI segment of Loop 2300. Additionally, any early adopters of the HIPAA 5010 Institutional transaction set will be required to submit the Value Codes for covered and non-covered days.

Direct Data Entry users of the MEDI System will also be required to submit the Value Codes for covered and non-covered days effective with the 5010 DDE implementation.

Any questions regarding this notice may be directed to the facility's medical assistance consultant in the Bureau of Comprehensive Health Services at 877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs