X12 defines and maintains transaction sets that build the data content material exchanged for particular company purposes and, occasionally, implementation guides that explain the usage of one or more transaction sets linked to an individual company objective or use case. The diagrams on the subsequent web pages depict different exchanges in between trading associates.
This drug/provider/offer is not really included in the charge agenda or contracted/legislated rate arrangement.
Each individual suggestion will cover a list of logically grouped transactions and may contain supporting information that may assist reviewers because they think about the features enhancements and other revisions.
These codes describe, establish, or clarify the insurance policy being noted within an eligibility and Gains response.
X12 is nicely-positioned to continue to serve its associates and the big set up base by continuing to assist the prevailing metadata, benchmarks, and implementation tools whilst also concentrating on various important collaborative initiatives.
X12 provides 3 types of files to facilitate regularity across implementations of its work.
Alert: It is a break up assistance and signifies a portion of the units with the originally submitted services.
A Personnel Payment Policy written for a particular work internet site, that may involve or cover more than one insured.
Some vital factors in your application include things like the type and dimension of your respective Business, your named Key agent, and committee-subcommittee you intend to participate with.
A not usually labeled or unlisted treatment code(s) was billed but a narrative description in the method was not entered on the assert. Refer to product 19 to the HCFA-1500.
Payment has long been (denied for that/made only for a less comprehensive) service/merchandise because the information furnished won't substantiate the need for the (far more considerable) services/merchandise.
Payment for x12 this support previously issued to you or another service provider by A further provider/intermediary.
You chose that this support/provide/drug will be rendered/provided and billed by a special practitioner/supplier.
Not paid to practitioner when furnished to patient On this position of services. Payment included in the reimbursement issued the power.