Subpart J of the regulations specifies that nonmedical code sets be valid at the time of transaction initiation (see below).
This seems straight forward until the supply chain process is examined. If a claim is not sent directly to the final destination, the claim is likely to go through at least 1 hop before reaching the final destination, causing subjectivity to the definition of the transaction initiation date. Is the transaction initiation date the date in which the provider initiated the transaction or the initiation date of the last hop in the cycle before the transaction reaches the final destination? The importance of this definition comes into play when the code changes between the time the transaction initiated from the provider to the time the payor receives the claim, since the lag time could be days. If transactions were always received the same day transactions were sent, this would not be an issue. If this topic has already been discussed, please direct me to the thread. Thank you for your input. Subpart J-Code Sets � 162.1000 General requirements. When conducting a transaction covered by this part, a covered entity must meet the following requirements: (a) Medical data code sets. Use the applicable medical data code sets described in � 162.1002 as specified in the implementation specification adopted under this part that are valid at the time the health care is furnished. (b) Nonmedical data code sets. Use the nonmedical data code sets as described in the implementation specifications adopted under this part that are valid at the time the transaction is initiated. Stacy Questions or comments contained herein are not the opinion or position of John Deere Health Care, Inc. or John Deere Health Plan, Inc. Stacy Cruise John Deere Health 3800 23rd Ave Moline, Illinois 61265 Phone: 309-765-0465 Fax: 309-749-1239 E-mail: [EMAIL PROTECTED] 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.
