Coding for HIPAA

These code sets include:

• Provider Taxonomy. Required by more and more Insurance Companies, Provide Taxonomy is a standard administrative code set for identifying the provider type and area of specialization for all health care providers. A complete list of the Provider Taxonomy code set is included in this publication.
• Claim Adjustment Reason. This code set is used to communicate why a claim or service line was "adjusted", which means why a claim or service line was paid differently than it was billed.
• Remittance Advice Remark. This code set adds greater specificity to a Claim Adjustment Reason Code. Remark Codes are used in a remittance advice to relay informational messages that cannot be expressed with a Claim Adjustment Reason Code.
• Claim Status Category. This code set indicates the general category of the status of a claim within the adjudication process (eg, accepted, rejected, additional information requested, etc).
• Claim Status. This code set further communicates information about the status of a claim.
• Place-of-Service. This code set specifies the entity where service(s) are rendered.

Narcisi, director of the Office of Electronic Medical Systems for the American Medical Association, examines the third-party CMS-1500 claim form in detail, gives a brief overview of the electronic transactions standards mandated by the US Department of Health and Human Services, and addresses the non-medical code sets required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). After an overview of HIPAA, chapters cover HIPAA code sets, the Health Care provider Taxonomy code set, the Claim Adjustment Reason code set, remittance advice remark codes, claim status codes, place-of-service codes for professional claims, the National Uniform Claim Committee Data Set. A final chapter gives detailed instructions for filling out the CMS-1500 claim form. Annotation ©2004 Book News, Inc., Portland, OR