Others titles
- Health Insurance Portability and Accountability Act (HIPAA) Standard Electronic Transactions
- Medicare Appropriate Report Type Codes
- Health Insurance Exchange-related Report Type codes
- Report Type Codes for CMS shop and Individual market
- CMS Report Type Codes
- CMS Exchange-related Report Type codes
- Statement on Standards for Attestation Engagements (SSAE) Reports
Keywords
- Report Type Codes
- Exchange-related Report Type codes
- Health Insurance Exchange Code Lists
- ASC X12 Documentation
- Code Checker
- Health Insurance
- Insurance Code
- Insurance Electronic Transactions
Health Care Insurance Report Type Codes
![Health Care Insurance Report Type Codes](https://www.johnsnowlabs.com/wp-content/uploads/2018/09/normal/Health-Care-Codes-Lists.png)
Healthcare Insurance Report Type Codes is a dataset that defines the type of report being described in an insurance claim and are transmitted in 005010X306, loop 2300, REF03. This dataset also contains information on the different report type codes and their descriptions, start and modified dates, and the status of each code whether active, to be deactivated or deactivated.
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Description
Healthcare Insurance Report Type Codes are transmitted in 005010X306, loop 2300, REF03. They define the type of report being described. The pertinent ASC X12 documentation is available in ASC X12 Stores.
The Centers for Medicare & Medicaid Services (CMS) maintain and annually update a List of Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) Codes (Code List), which identifies all the items and services included within certain DHS categories. CMS updates the Code List to conform the list to the most recent publications of CPT and HCPCS and to account for changes in Medicare coverage and payment policies. The updated Code List is published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule. That rule is usually published in November and generally becomes effective January 1 of the following year. In addition, we may publish other rules or correction notices that may change the Code List. CMS posts any changes to the Code List on its webpage as soon as possible after publication in the Federal Register.
The DHS categories defined by the Code List are:
– Clinical laboratory services;
– Physical therapy services, occupational therapy services, outpatient speech-language pathology services;
– Radiology and certain other imaging services; and
– Radiation therapy services and supplies.
**NOTE**: The following DHS categories are defined at 42 CFR §411.351 without reference to the Code List:
– Durable medical equipment and supplies;
– Parenteral and enteral nutrients, equipment and supplies;
– Prosthetics, orthotics, and prosthetic devices and supplies;
– Home health services;
– Outpatient prescription drugs; and
– Inpatient and outpatient hospital services.
About this Dataset
Data Info
Date Created | 2013-10-01 |
---|---|
Last Modified | 2021-06-07 |
Version | 2021-03-01 |
Update Frequency |
Irregular |
Temporal Coverage |
2013 to 2021 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers of Medicare and Medicaid Services (CMS); |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Report Type Codes, Exchange-related Report Type codes, Health Insurance Exchange Code Lists, ASC X12 Documentation, Code Checker, Health Insurance, Insurance Code, Insurance Electronic Transactions |
Other Titles | Health Insurance Portability and Accountability Act (HIPAA) Standard Electronic Transactions, Medicare Appropriate Report Type Codes, Health Insurance Exchange-related Report Type codes, Report Type Codes for CMS shop and Individual market, CMS Report Type Codes, CMS Exchange-related Report Type codes, Statement on Standards for Attestation Engagements (SSAE) Reports |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Code | Report Type Codes | string | required : 1unique : 1 |
Description | Description for each Report Type Code | string | required : 1unique : 1 |
Start_Date | Date the Report Type Code started usage | date | required : 1 |
Last_Modified | Date the Report Type Code was changed/modified | date | - |
Stop_Date | Date the Report Type Code was deactivated/stopped | date | - |
Status | Code update whether Active, To be Deactivated or Deactivated | string | - |
Notes | Explanation of the coverage for each Report Type Code | string | required : 1 |
Data Preview
Code | Description | Start_Date | Last_Modified | Stop_Date | Status | Notes |
INVOICERPT | References an Invoice number related to the Exchange Payment Type Code in the 2300 Loop | 2013-10-01 | 2015-11-01 | Active | CMS Individual Market Only | |
ISSUERIDRPT | References an Issuer (5-digit) HIOS ID number related to the Exchange Payment Type Code in the 2300 Loop | 2015-11-01 | Active | CMS Individual Market Only | ||
PAYMENTTRANSACTIONID | This will be the Payment Transaction ID for the initial payment ID if this is an initial payment. | 2014-11-01 | 2015-11-01 | Active | CMS SHOP Market Only | |
BALRPT | The report type code that corresponds to BAL Payment Type code to provide additional details for the transaction. | 2015-01-11 | Active | CMS All Programs and Relevant Markets | ||
INFORPT | The report type code that corresponds to any Payment Type code to provide additional details for the transaction. | 2016-10-18 | Active | CMS All Programs and Relevant Markets | ||
SHOPUFRPT | The number included in the document control number references a unique trace number (TRN02) from a corresponding SHOP HIX 820 transaction. | 2015-11-01 | CMS Individual Market Only | |||
REVMADJRPT | The number included in the document control number references a unique trace number from a prior month HIX 820 where the manual adjustment first occurred. | 2013-10-01 | 2015-11-01 | 2015-11-01 | Deactivated | CMS Individual Market Only |
MADJRPT | The number included in the document control number references a unique trace number that may be included on a future HIX 820 if the manual adjustment is reversible. | 2013-10-01 | 2015-11-01 | 2015-11-01 | Deactivated | CMS Individual Market Only |
AFFRPT | References an affiliate payee ID and HIX 820 EFT Trace Number (TRN02) that will allow the payee to identify the affiliate related to the Exchange Payment Type Code in the 2300 Loop. | 2013-10-01 | 2015-11-01 | 2015-05-01 | Deactivated | CMS Individual Market Only |
INFORPT | The report type code that corresponds to any Payment Type code to provide additional details for the transaction. | 2016-10-18 | Active | CMS All Programs and Relevant Markets |