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  5. 837 Institutional and Professional Transactions

837 Institutional and Professional Transactions 

Version 5010 is the new version of the X12 standards for HIPAA transactions and replaces 4010/4010A1. Version D.0 is the new Version for NCPDP, standards for pharmacy transactions and replaces version 5.1. HFS is preparing all systems to accept both Versions 5010 and D.0 in accordance with federal timelines. Below is an initial list of FAQs that should be helpful to our internal staff, helping all employees gain awareness and understand the implementation initiatives.
  1. How will HFS handle the 5010 configuration of the pay to loop?
    HFS will no longer support a separate pay to location. If an address is submitted in the pay to loop, the information will be ignored. Please see Companion Guides for further information.
  2. Is the billing provider taxonomy required on all claims?
    Yes. HFS requires that all 837 Institutional and 837 Professional transactions contain the billing provider taxonomy code. The 2000A - PRV segment containing the billing provider taxonomy code is required on all claims.
  3. Are there any changes to how third party payments are to be submitted to Healthcare and Family Services?

    There are no changes to how the TPL code and TPL status code are to be reported. Please see Companion Guides for further information.