100-04 Medicare Claims Processing Manual: Chapter 25 Crosswalk

Medicare Claims Processing Manual
Chapter 25 - Instructions for Completing UB-92, NSF, and Related ANSI X12 Formats
Crosswalk
New
Chap.
New
Sect.
Int.
Pub. 13-3
Hospital
Pub 10
Other 	Program
Memo
Description
25 	10 	AB-03-036 	FI Implementation of the Health Insurance Portability and
Accountability Act (HIPAA) Health Care Eligibility Benefit
Inquiry/Response Transaction (270/271) Standard
25 	20 	A-01-20,
A-01-63,
B-00-68,
B-01-06,
B-01-32
Health Insurance Portability and Accountability Act (HIPAA)
Health Care Claim and Coordination of Benefits
25 	20.1 	B-01-06 	Decimal Data Elements
25 	20.2 	A-01-20 	Transmission Mode - Inbound X12N837 HIPAA version claim
25 	20.2 	B-01-06 	Transmission Mode - Inbound X12N837 HIPAA version claim
25 	20.3 	A-01-20 	Free Billing Software
25 	20.4 	A-01-20 	External Keyshop or Imaging Processing
25 	20.5 	A-01-20,
B-01-06
Provider Direct Data Entry (DDE)

New
Chap.
New
Sect.
Int.
Pub. 13-3
Hospital
Pub 10
Other 	Program
Memo
Description
25 	20.6 	A-01-20,
A-01-63,
A-02-119
Edits Performed by the FI
25 	20.7 	A-01-20,
A-01-63
Edits Performed by the Standard systems
25 	20.8 	A-01-63 	Attachment Data Processing
25 	20.9 	Related Internet Files Routinely Updated by CMS
25 	30 	A-00-89,
A-01-20,
B-01-06
Coordination of Benefits
25 	30.1 	A-01-20 	Transmission Mode - Outbound X12N 837 COB Transaction
25 	30.1 	B-01-06 	Transmission Mode - Outbound X12N 837 COB Transaction
25 	30.2 	A-01-20 	External Keyshop or Imaging Processing
25 	30.3 	A-01-20,
B-01-06
Summary of Process
25 	30.4 	AB-02-54 	Generating an Outbound Coordination of Benefits (COB) X12N
837 (4010) When Required Data is Missing or Invalid
25 	30.5 	A-01-20 	Outreach
25 	50 	Uniform Bill - CMS-1450

New
Chap.
New
Sect.
Int.
Pub. 13-3
Hospital
Pub 10
Other 	Program
Memo
Description
25 	50.1 	A3-3604 	HO-460 	HHA-475,
HSP-302,
OPT-416,
RDF-320,
SNF-560
Uniform Billing With Form CMS-1450
25 	50.2 	HO-431.1 	HHA-422 	Disposition of Copies of Completed Forms
25 	60 	A3-3604,
A3-3873.2
HO-461 	HHA-475,
OPT-416,
RDF-320,
SNF-560
A-03-032,
A-03-059,
R1894A3
General Instructions for Completion of Form CMS-1450 For
Billing
25 	70 	A3-3606 	HO-462 	Form CMS-1450 Consistency Edits
25 	80 	A3-3664 	HO-411.1,
IM-HO-411.1,
HO-415.11
HHA-445 	Adjustments
25 	80.1 	A3-3664B 	General Rules for Submitting Adjustment Requests
25 	80.1.1 	A3-3664D 	Adjustment Bills Involving Time Limitation for Filing Claims
25 	80.1.2 	HO-411.2,
IM- HO-411.2
HHA-445 	Claim Change Reasons
25 	80.1.2.1 	Claim Change Reason Codes
25 	80.1.2.2 	Edits on Claim Change Reason Codes
25 	80.1.2.3 	Additional Edits

New
Chap.
New
Sect.
Int.
Pub. 13-3
Hospital
Pub 10
Other 	Program
Memo
Description
25 	80.1.3 	HO-411.2,
IM-411.2
Late charges
25 	80.2 	A3-3664,
A3-3610.8
IM-HO-411.1,
HO-415.11
HHA-445 	Inpatient Part A Hospital Adjustment Bills
25 	80.2.1 	A3-3664.1A 	Tolerance Guidelines for Submitting Inpatient Part A Hospital
Adjustment Requests
25 	80.3 	SNF Part A Adjustments
25 	80.3.1 	SNF-515.5 	Adjustment to HIPPS Codes Resulting From MDS Corrections
25 	80.3.1.1 	Effective Date for Adjustment Billing
25 	80.3.1.2 	SNF-562 	Tolerance Guides for Submitting SNF Inpatient Adjustment
Requests
25 	80.3.2 	SNF Inpatient Paper Claims
25 	80.3.3 	SNF Inpatient Electronic Claims Using the UB-92 National
Format (Version 060)
25 	80.3.3.1 	Billing Instructions-SNF Inpatient Electronic Claims Using the
ANSI ASC X-12 837 (Version 3051)
25 	80.3.3.2 	Billing Instructions-SNF Inpatient Electronic Claims Using the
ANSI ASC X-12 837 (HIPAA version)

New
Chap.
New
Sect.
Int.
Pub. 13-3
Hospital
Pub 10
Other 	Program
Memo
Description
25 	80.3.4 	Patient Does Not Return From SNF Leave of Absence, and Last
Bill Reported Patient Status as Still Patient (30)
25 	80.4 	Hospital and SNF Part B Adjustment Requests
25 	80.4.1 	Guidelines for Submitting Adjustment Requests
25 	80.5 	Home Health Adjustments
25 	80.5.1 	Submitting Adjustment Requests
25 	90 	Provider Electronic Billing File and Record Formats - UB-92
Version 6
25 	90.1 	Recommended Physical File Specifications - Magnetic Tape
25 	90.2 	File Specifications - Media Other Than Magnetic Tape
25 	90.3 	Record Specifications
25 	90.4 	Key to Records
25 	90.5 	Record Layouts
25 	100 	CMS-1450, UB-92, ANSI 837A 4010 and 3051 3A.01 Crosswalk
of Data Elements

New
Chap.
New
Sect.
Int.
Pub. 13-3
Hospital
Pub 10
Other 	Program
Memo
Description
25 	110 	Add. A 	Notes for Benefit Coordination
25 	120 	Coordination of Benefits Records - COB - I/O Records
25 	130 	Add. B 	Alphabetic Listing of Data Elements Used in UB-92 Version 6
25 	140 	Home Health Data Elements - Cross Reference
25 	Exh 1 	Exhibit 1 - Heading Descriptions of Medicare Part A Claim/COB
flat file layout (4010837i.xls)