We have an ask from our business partners and hoping you could provide us with input on their ask. We think B6 would be the best consideration, but we really need workgroup input. Are you able to provide the input to this ask?
Due to the finalized rules for Federal No Surprises Act HR 133 Regulation, payors are now required to provide qualifying payment amount (QPA) for both original and down coded codes on the 835 (dependent on delivery preference). To adhere to the ANSI 835 standards and HIPAA compliance, we can only consider B6, KH, T, T2, ZK-ZO. We think B6 would be the best consideration, but we really need workgroup input.
The current 5010 835 TR3 does not support sending this information. There is no place within the 835 to report any amounts for QPA. B6 is for the actual allowed amount so it cannot be used for QPA as the amount must be a non-zero amount.
This functionality is being considered for future versions via MR# 280
Related RFIs: 2634