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Institutional Claims Only 

Select the Frequently Asked Question to view answer.
  1. What are the major changes for the 837 Institutional transaction with HIPAA 5010?
    With the implementation of HIPAA 5010, the largest change to the transaction set is that the QTY segment where covered days and non-covered days were being sent in was removed. Illinois Medicaid is now looking for the covered days and non-covered days to be sent in the value code segment. All claims requiring the reporting of covered and non-covered days will need to submit the covered days value code of 80 and for non-covered days value code of 81 with the corresponding number of days in the value amount fields.
  2. In HIPAA 5010 the Admission Date segment now allows for both a date and a date and time qualifier, are there any guidelines for when each should be used for the 837 Institutional transaction?

    For institutional claims the Admission date and time qualifier (DT) and value must be used on all Inpatient claims. For an outpatient claim the Admission Date only (D8) qualifier and value will be accepted.

  3. What changed in the Errata versions for institutional claims?

    The most significant change in the 837 Institutional Errata versions was that Admission Type code became required on all claims. The value is to be reported in the 2300 CL1 segment on every claim.

  4. Are POA values still required to be sent in on the K3 segments on Institutional claims?

    No. POA values have their respective places in the 5010 837 Institutional transaction on the diagnosis segments. Refer to the implementation guide for how to submit those values. The K3 segment no longer should carry those values.