Key Shop and Image Processing

60.2.2 - Key Shop and Image Processing (Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13) Key shop, imaging, and contractor in-house data entry operations that do not output directly in the ASC X12 837 claim or ASC X12-based flat file format, must convert their initial output format into the ASC X12-based flat file or the ASC X12 837 claim format prior to transmission to their data center. When the ASC X12-based flat file is the output, the REF01 segment/element (found prior to the ST segment) shall contain a value of “+PR” and REF02 shall contain a value of “K” (external key shop or in-house data entry) or “O” (OCR/ICR). Shared systems shall apply IG edits only to those requirements that are applicable to both the HIPAA and the corresponding fields on the paper claim. Implementation guide edits that are inappropriate for paper claims shall be by-passed. An outbound ASC X12 837 claim COB transaction built from a paper claim will be produced as a “skinny” COB. Gap filling must occur as needed to enable the file sent to the trading partner to meet minimum data set requirements for a compliant ASC X12 837 claim COB transaction. “Skinny” COBs shall contain all required ASC X12 837 claim segments and include post-adjudicated data.