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Elizabeth M. Whitehorn, Director

Provider Notice dated 12/14/11

Diagnosis Code Requirement for 5010 837P Electronic Claim Submission

​To: ​Participating Transporation Providers
​Date: ​December 14, 2011
​Re: ​Diagnosis Code Requirement for 5010 837P Electronic Claim Submission

 

The 5010 837P electronic transaction, which becomes effective January 1, 2012, requires a diagnosis code on all 837P electronic claims. All transportation claims submitted in the version 5010 837P electronic claim format must comply with the requirement to include a diagnosis code.

Transportation providers must report an ICD-9 diagnosis code that is provided to them by the treating physician or other practitioner. If no diagnosis code is available, providers may use the ICD-9 diagnosis code 799.9 (unspecified illness).

 

This requirement does not apply to the 4010A1 837P electronic transaction or paper claims. HFS will continue to accept 4010 transactions through December 31, 2011.

 

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565, Billing Questions, Option #3, and then Option #3.

 

 

Theresa A. Eagleson, Administrator
Division of Medical Programs