Best Practice Recommendations for HIPAA Transaction Exchange

Health Plans and Providers are working together to develop best practice recommendations for implementing and using the HIPAA transactions.  Though HIPAA mandates how the transactions should be formatted and what codes are valid, HIPAA does not standardize how the transactions should be used to convey information in a meaningful way.  By adhering to these Best Practice Recommendations, health plans and providers can help to ensure that a HIPAA transaction will mean the same thing no matter who sends or receives it.

• Best Practice Recommendation for Usage of Group Codes, Reason Codes and Remark Codes
This document outlines a set of Best Practice Recommendations for using HIPAA denial and adjustment codes on the 835 Remittance Advice Transaction.  Business usage recommendations are discussed for all 5 Group Codes and for Reason Codes 16, 17, 125 and 96, along with the common Remark Codes associated with those Reason Codes.

Implementation Timeline
Health Plan Name	Implementation Date
First Choice	3/01/08
Group Health	Done
Premera	Done
Regence	Done

» Best Practice Recommendation – Usage of Group, Reason & Remark Codes
   (.pdf | 640K | 05.27.08)

• Best Practice Recommendation for Electronic Processing of Corrections to Claims
These documents outline a set of Best Practice Recommendations for using the 837 Claim Transaction to send corrected claims to a health plan.  As health plans and providers adhere to these recommendations, providers should no longer receive erroneous ‘Denied as Duplicate’ denials.

Implementation Timeline
Health Plan Name	Implementation Date
First Choice	3/01/08
Group Health	Done
Premera	Done
Regence	To Be Determined

» Best Practice Recommendation – Professional Claims
   (.pdf | 34K | Rev 7.0 | 11.30.06)

» Best Practice Recommendation – Institutional Claims
   (.pdf | 34K | Rev 7.0 | 11.30.06)