ASC X12 835 Implementation Guide (IG) or Technical Report 3

40.6 – ASC X12 835 Implementation Guide (IG) or Technical Report 3 (TR3) (Rev. 10236, Issued: 07-31-2020, Effective: 08-31-2020, Implementation: 08-31-2020) The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that Medicare, and all other health insurance payers covered under HIPAA comply with the electronic data interchange standards for health care as established by the Secretary of Health and Human Services. The 5010A1 version of the ASC X12 835 Technical Report 3 TR3 has been established as the standard for compliance for the 5010A1 version of the ASC X12 835remittance advice transaction... The formal name of this TR3 is ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—Health Care Claim Payment/Advice (835), and its current HIPAA compliant version is available electronically at the official Washington Publishing Company website. Although that TR3 or implementation guide contains requirements for use of specific segments and data elements within the segments, it was written for use by all health plans and not specifically for Medicare. However, a Companion Document has been prepared by CMS to clarify when conditional data elements and segments must be used for Medicare reporting when reviewing the Companion Document, keep in mind the following information about loop usage (e.g., required, not used, and situational definitions). For additional information on this subject see the Implementation Guide: • Loop usage within ASC X12 transactions and their implementation guides can be confusing. Care must be used to read the loop requirements in terms of the context or location within the transaction. • The usage designator of a loop’s beginning segment indicates the usage of the loop. Segments within a loop cannot be sent without the beginning segment of that loop. • If the first segment is required, the loop must occur at least once unless it is nested in a loop that is not being used. A note on the required first segment of a nested loop will indicate dependency on the higher-level loop. • If the first segment is Situational, there will be a Segment Note addressing use of the loop. Any required segments in loops beginning with a Situational segment occur only when the loop is used. Similarly, nested loops occur only when the higher-level loop is used. Companion Documents for both Part A and Part B are available at: http://www.cms.gov/ElectronicBillingEDITrans/30_CompanionGuides.asp#TopOfPage