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Companion Guide for Pharmacy Professional Claims |
 Washington Publishing Company has been approached
by a number of organizations to publish industry specific Companion Guides to
the X12N Implementation Guides adopted for use under HIPAA. These industry
groups have seen the value in having Companion Guides created to lessen the
burden for developers within their industry.
The X12N Implementation
Guides were developed to cover all known business scenarios for their related
transaction and cross many different industries that are mandated by HIPAA to
use the X12N Implementation Guides. Sifting through these all encompassing
Implementation Guides for specific requirements applicable to a specific
industry or line of business has proven to be a time consuming and frustrating
task. For example, information about Ambulance Certification is of no value to
a Pharmacy provider attempting to create a claim for professional
services.
Every effort has been made to create HIPAA compliant sub-set
Companion Guides, but they are not intended to supercede the X12N Implementation
Guides adopted for use under HIPAA.
Unlike the X12N Implementation Guides adopted for use under HIPAA,
these Companion Guides are typically not free for downloading. Fees are
charged, when necessary, to recover the costs associated with the
development and distribution of these Companion Guides.
A national expert Advisory Panel was convened by the Pharmacist
Services Technical Advisory Coalition (PSTAC, formerly the X12 Advisory
Panel) to compile an instructional guide on the transaction segments of
the X12N 837 that are germane to claims for pharmacy professional
services, along with sample illustrative cases of claims involving
medication therapy management services, diabetes self-management
training, lab tests, a certificate of medical necessity, referring
provider vs. ordering provider vs. supervising provider vs. rendering
provider, coordination of benefits, and provider "incident to"
billing. More information on PSTAC can be found at www.pstac.org
This Companion Guide is based on the May 2000 ASC X12N Insurance
Subcommittee Implementation Guide 004010X098A1 Health Care Claim:
Professional and the October 2002 Addenda. The Companion Guide
standardizes the data content used by the pharmacy industry for the
purpose of submitting healthcare claims for professional services
rendered in a pharmacy setting. This companion document provides
guidance on what translators must be able to impart in support of this
companion document.
Transactions based upon this companion document are still compliant
with both X12 syntax and the HIPAA Healthcare Claim: Professional
Implementation Guide 004010X098.
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