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Eligibility/Benefit Inquiry and Information Response (/), its related .. The implementation guides for X12N and all other HIPAA standard transactions are available .. technical report type 3 documents and code sets. . by calling toll-free at option 2, 0, and then 3. / Eligibility Benefit Inquiry and Response Companion Guide- HIPAA version Version .. The ANSI X12N TR3s and Erratas adhere to the final HIPAA Transaction Regulations and have been are available electronically at Free Standing Prescription Drug. Medicaid / HIPAA Companion Guide .. the ANSI X12 and transactions may be found at or can Free-Form Message Text.

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Additional information requested from entity. Certification Condition Indicator Start: Report of prior testing related to this service, including dates Start: Submit newborn services on mother’s claim Start: Drug days supply and dosage. Hospital s semi-private room rate. Obstetric Additional Units Start: Can patient operate controls of bed?


Verification of patient’s ability to retain and use information Start: Speech pathology treatment plan. Entity’s anesthesia license number.

Explain why hearing loss not correctable by hearing aid Start: Entity not referred by selected primary care provider.

Most recent date of curettage, root planing, or periodontal surgery. Is patient confined to bed? Cannot process individual insurance policy claims.

Procedure code not valid for patient age Start: Specific findings, complaints, or symptoms necessitating service Start: Date Error, Century Missing Start: Revenue code and patient gender mismatch Start: Is patient confined to room?

Oxygen Test Condition Code Start: See STC12 for details. Maximum coverage amount met or exceeded for benefit period. Number of lesions excised. Entity not approved as an electronic submitter. Facility point of origin and destination – ambulance. Prior fref, including result s and date s as related to service s Start: Charges pending provider audit. Entity’s preferred provider organization id PPO.

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This code should only be used to indicate an inconsistency between two or more data elements on the claim. Peer Review Authorization Number Start: Patient Condition Description Start: Documentation from prior claim s related to service s Start: Indicating why medications cannot be taken orally Start: Entity’s specialty license number. Claim submitted to incorrect payer.


At the gulde request these claims cannot be submitted electronically.

For Providers

Refer to code Other employer name, address and telephone number. Type of bill for UB claim Start: Did provider authorize generic or brand name dispensing?

Use codes or Originator Application Transaction Identifier Start: Information was requested by an electronic method. Entity does not meet dependent or student qualification. Amount must be greater than zero.

Purchase and rental price of durable medical equipment. Were services related to an emergency? Date of dental appliance placed. Claim contains split payment.