CMS 837I NOA Companion Guide - Centers for Medicare ...

1 CMS 837I NOA Companion Guide 1 CMS Companion Guide Transaction Information Instructions related to the Non-Standard Use of the 837 health C a re C la im: Institutio na l Transaction as a Home health Notice of Admissio n based on ASC X12 Technical Report Type 3 (TR3), version 005010A2 Companion Guide Version Number: May 2021 CMS 837I NOA Companion Guide 2 Preface Companion Guides (CGs) may contain two types of data, instructions for electronic communications with the publishing entity (Communications/Connectivity Instructions) and supplemental information for creating transactions for the publishing entity while ensuring compliance with the associated ASC X12 IG (Transaction Instructions).

2 Either the Communications/Connectivity component or the Transaction Instruction component must be included in every CG. The components may be published as separate documents or as a single document. The Communications/Connectivity component is included in the CG when the publishing entity wants to convey the information needed to commence and maintain communication exchange. The Transaction Instruction component is included in the CG when the publishing entity wants to clarify the IG instructions for submission of specific electronic transactions.

3 The Transaction Instruction component content is in conformance with ASC X12 s Fair Use and Copyright statements. CMS 837I NOA Companion Guide 3 Table of Contents Trans ac tion Ins truc tion (TI) ..3 1. TI I ntroduction .. 4 Bac kground ..4 Ov er v iew o f HI P AA 4 Compliance according to Compliance according to ASC X12 ..4 Intended Us e ..5 2. I nclude d ASC X12 I mple mentation Guide s .. 5 3. I ns t ruct ion Table .. 5 005010X223A2 health care Claim: 4.

4 TI Additional Information .. 11 Change Log .. 11 CMS 837I NOA Companion Guide 4 Transaction Instruction (TI) 1. TI Introduction Background Overview of HIPAA Legislation The health Insurance Portability and Accountability Act (HIPAA) of 1996 carries provisions for administrative simplification. This requires the Secretary of the Department of health and Human Services (HHS) to adopt standards to support the electronic exchange of administrative and financial health care transactions primarily betw een health care providers and plans.

5 HIPAA directs the Secretary to adopt standards for transactions to enable health information to be exchanged electronically and to adopt specifications for implementing each standard HI P AA s er v es t o : Create better access to health insurance Limit fraud and abuse Reduce administrative costs Compliance according to HI PAA The HIPAA regulations at 45 CFR require that covered entities not enter into a trading partner agreement that would do any of the following: Change the definition, data condition, or use of a data element or segment in a standard.

6 Add any data elements or segments to the maximum defined data set. Use any code or data elements that are marked not used in the standard s implementation specifications or are not in the standard s implementation s pec if ic ation( s) . Change the meaning or intent of the standard s implementation s pec if ic ation( s ) . Compliance according to ASC X12 ASC X12 requirements include specific restrictions that prohibit trading partners from: Modifying any defining, explanatory, or clarifying content contained in the implementation Guide .

7 Modifying any requirement contained in the implementation Guide . Use for a Non-HIPAA Transaction This Transaction Instruction uses a standard transaction format for the submission of home health Notices of Admission (NOAs). The NOA is not a HI P AA-covered transaction. It does not meet the definition of a claim or CMS 837I NOA Companion Guide 5 encounter at 45 CFR because it does not request payment or report health care services. While the contents of this Transaction Instruction meet the compliance requirements described in sections and , this is a non-standard use of 837I Implementation Guide .

8 Medicare -participating home health agencies may adopt the use of this Transaction Instruction for NOAs on a strictly voluntary basis and as an optional extension of their existing trading partner agreement w ith the Medicare program and their Medicare Administrative Contractor. Medicare encourages home health agencies to submit groups of NOAs in separate batch transmissions from groups of claims . T his pr ac tic e may reduce the risk that translator-level rejections related to NOAs, if they occur, could impact payments to the home health agencies.

9 NOAs will receive 277CA acknowledgements. They will not be reported on the 835 remittance advice. Intended Use The Transaction Instruction component of this Companion Guide must be used in conjunction with an associated ASC X12 Implementation Guide . The instructions in this Companion Guide are not intended to be stand-alone requirements documents. This Companion Guide conforms to all the requirements of any associated ASC X12 Implementation Guides and is in conformance with ASC X12 s Fair Use and Copyright statements.

10 2. Included ASC X12 Implementation Guides This table lists the X12N Implementation Guide for which specific transaction Instructions apply and which are included in Section 3 of this document. Unique ID Na m e 005010X223A2 health care Claim: Institutional (837) 3. Instruction Ta ble This table contains rows for where supplemental instruction information is located. The order of table content follows the order of the implementation transaction set as presented in the corresponding implementation Guide .