Jan. 7, 2022

New Edits for Inpatient Billing

Beginning March 1, 2022, Blue KC will have new data elements required on inpatient institutional claims (837I).

All institutional claims (837I) with an inpatient bill type of 11x (Loop 2300/CLM05) that contain a patient status code (Loop 2300/CL103) equal to one of the following: 02, 03, 05, 50, 51, 61, 62, 63, 65, 66, 70, and have an admit date (Loop 2300/DTP03) that is the same as the statement through date (Loop 2300/DTP03), must contain a valid condition code (Loop 2300/HI01:2) to avoid a claim rejection. Claims without a valid condition code will receive a 277CA rejection of A6:460.

Please use the following chart for reference to the new required data elements and edit:

Name of Data Element 837I Loop and Data Element Data Element Information
Inpatient Bill Type Loop 2300
CLM05		 11x
Patient Status Code Loop 2300
CL103		 02, 03, 05, 50, 51, 61, 62, 63, 65, 66, 70
Admit Date Loop 2300
DTP03		 Same as statement through date
Statement Through Date Loop 2300
DTP03		 Same as admit date
Code List Qualifier Loop 2300
HI01:1		 BG
Condition Code Loop 2300
HI01:2		 Applicable Condition Code

 

All institutional claims (837I) with an inpatient bill type of 11x (Loop 2300/CLM05) and a operating room revenue code equal to 036x (Loop 2400/SV201) will require a valid principal procedure code (Loop 2300/HI01:2). Claims without a valid principal procedure code will receive a 277CA rejection of A6:465. Please use the following chart for reference to the new required data elements and edit:

Name of Data Element 837I Loop and Data Element Data Element Information
Inpatient Bill Type Loop 2300
CLM05		 11x
Revenue Code Loop 2400
SV201		 036x
Code List Qualifier Loop 2300
HI01:1		 BBR
Principal Procedure Code Loop 2300
HI01:2		 Applicable ICD-10 Principal Procedure Code

 

For more information on electronic claims or questions, please call the Blue KC provider hotline at 816-395-3929.

BLUE highlighted boxes are the lines of business impacted by this update.
LINES OF BUSINESS IMPACTED
COMMERCIAL Blue Medicare Advantage ACA QHP1 Small Group ACA JAA2 FEP3 Dental

 

1 ACA QHP: Affordable Care Act Qualified Health Plan for Individual/Family
2 JAA: Joint Administrative Account
3 FEP: Federal Employee Program