Recently, ASC X12 created a Technical Report Type 2 (TR2) called "Code Value Usage in Health Care Claim Payments and Subsequent Claims". Please explain the relationship between this document and the 005010X221 TR3 for the 835 currently mandated under HIPAA, as well as subsequent 835 TR3s, and why this information is in a TR2 instead of the 835 TR3.
The "Code Value Usage in Health Care Claim Payments and Subsequent Claims" TR2 (ASC X12N/2011-49 and revisions) is a tool to help the health care industry standardize code usage in the 835 transaction related to adjustments and to prepare the industry for changes to the 835 in future versions (beyond the TR3 005010X221).
Under version 5010, this is a voluntary aid to payers and providers using the 835. There is no direct or indirect usage requirement between 005010X221 and ASC X12N/2011-49. Usage of the TR2 is solely at the discretion of the entities creating a version 5010 835 transaction.
Subsequent versions of the 835 TR3 (ASC X12 version 006020 and beyond) will include:
1 - A structural change that replaces usage of the CAS segment with the RAS segment
2 - Requires conformance to the TR2.
The document has been created as a separate TR2 rather than internal to the TR3(s) for three reasons:
1 - To allow the industry to use the mappings voluntarily with version 5010 to enhance the standardization of the codified 835 adjustment information
2 – To allow the industry time to use the mappings voluntarily so that any business impacts can be identified and corrected prior to a requirement for use of the mappings. This will facilitate migration to a post version 005010 835
3 - So that the TR2 mappings stay in sync with changes to the related code lists that are external to ASC X12. Since those lists change up to three times a year, the industry needs to be able to adjust to code list changes regularly. Publishing the information in a TR2 external to the TR3 provides the responsiveness that the industry needs.