The line limits are, as you noted, stated in the guides (there's lots of detail stated in the guides that are not in the rule as published in the Federal Register). Because the rule references the guides, they become part of the rule so, in a sense, they are "in" 45 CFR parts 160 and 162.
Payers are allowed to accept HIPAA transactions but HIPAA does not dictate how they handle the information after they accept it. I suspect that line limits will be one of the early issues to be clarified. Many of the payers I work with will be splitting claims on the front end if they exceed the payers systems capacity. Each portion will be adjudicated separately. I think providers will soon learn that Payer A only processes claims of x lines and the providers will voluntarily split the claims on their end rather than let the payer (somewhat randomly) split the claim at their end. A randomly split claim could be problematic. Jan Root UHIN Kay Wyssbrod wrote: > The health care claim status codes for the 277 and the 835 are different. > Don't confuse them. The 277 uses code list 508; the 835 has an internal > list of status codes. > > "Brown, Kenneth" <[EMAIL PROTECTED]> on 05/28/2002 04:03:58 PM > > To: "'[EMAIL PROTECTED]'" <[EMAIL PROTECTED],>, > "'[EMAIL PROTECTED]'" <[EMAIL PROTECTED]> > cc: > Subject: Line Item Limits > > I am looking for direction as to the issue of the number of line items > which > may or may not be accepted within a 837 claim transaction.. I can not find > any reference to line item limitation within the 45 CFR parts 160 and 162. > In the implementation guide the number of 2400 loops (Service Line) is > limited to 50, within the 2400 loop the LX segment (line item counter) is > limited to one per loop, this is for the professional and the dental 837. > The 837 institutional guide has this limit as 999. > > The Health Care Claim Status Codes provided by the Washington Publishing > Company's web site www.wpc-edi.com is the only acceptable code list for use > in the 277 and 835 transaction sets. The description for code 121 is > stated > as "Service line number greater than maximum allowable for payer." This > leads me to believe a limit may be set as to the maximum line item per > payer. > > Any help is appreciated. > > Ken Brown > Interoperability Manager > > To be removed from this list, go to: > http://snip.wedi.org/unsubscribe.cfm?list=business > and enter your email address. > > The WEDI SNIP listserv to which you are subscribed is not moderated. The > discussions on this listserv therefore represent the views of the > individual participants, and do not necessarily represent the views of the > WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official > opinion, post your question to the WEDI SNIP Issues Database at > http://snip.wedi.org/tracking/. > Posting of advertisements or other commercial use of this listserv is > specifically prohibited. > > To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?list=business > and enter your email address. > > The WEDI SNIP listserv to which you are subscribed is not moderated. The >discussions on this listserv therefore represent the views of the individual >participants, and do not necessarily represent the views of the WEDI Board of >Directors nor WEDI SNIP. If you wish to receive an official opinion, post your >question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. > Posting of advertisements or other commercial use of this listserv is specifically >prohibited. To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address. The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
