on 5/29/2020 at 7:26 PM

Voting Results - IRR CLM900 Benefit Change Reason Code (DNXXXX)


From: Gregg Lutz

User Posts: 330 - Intermediate User

Download Attachment IRR CLM900 Work Group Meeting Notes.docx 35.97 kB 12 downloads

Business Requirement / Issue: Provide ability for Trading Partners to report a rate change electronically to comply with 12 NYCRR 300.23(a).

Final Proposed Resolution: Add a new data element to capture Benefit Change Reason Code (DNXXXX).

IRR CLM900 - BENEFIT CHANGE REASON CODE (DNXXXX)

Definition: A code reported at the Claim level identifying the reason the Benefit Type Code or Net Weekly Amount has changed.  This is not at the Benefit segment level.

DP Rule:  This DN can only be required/reported on a SROI MTC CB - Change in Benefit Type or CA - Change in Benefit Amount.  It does not apply to any other SROI MTC's.  This should not carry over to future transactions.  The jurisdiction should have a current statutory reason for requiring this DN and should be outlined in the jurisdiction's Trading Partner Tables.  The data element cannot be Mandatory if the reason for the change in the Net Weekly Amount or Benefit Type Code can be determined by another Data Element elsewhere in the standard.  

Values: (To be determined by Systems Committee)

? = Independent Medical Exam (IME) or Claim Administrator Consultant

? = Employee Treating Physician medical report    

? = Recalculation of Net Weekly Amount based on Wage Statement    

? = Jurisdiction Directed    

? = Stipulated or negotiated Net Weekly Amount (not jurisdiction directed)

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on 9/24/2020 at 10:28 PM

From: Lori Raby

User Posts: 32 - New User


Gregg Lutz wrote:

Voting for IRR CLM900 completed on Wednesday, July 22, 2020. The proposed resolution was APPROVED along with the implementation timeline.

A total of 30 responses were received consisting of 24 Yes Votes, 1 No Vote and 5 Abstentions. Per the requirements of the IRR process, a two-thirds majority is required for an IRR to be considered approved. The outcome of this vote exceeded the two-thirds requirement with 96% in favor of the proposed resolution. A detailed report of the voting results for CLM900 is attached.

Benefit Change Reason Code - one byte AN field was assigned DN0439 and will be in position 634 of the SROI R22 layout

                      Values were assigned to the approved code list for the new data element:

     

A = Independent Medical Exam (IME) or Claim Administrator Consultant

     

B = Employee Treating Physician medical report

     

C = Recalculation of Net Weekly Amount based on Wage Statement

     

D = Jurisdiction Directed

                 E = Stipulated or negotiated Net Weekly Amount (not jurisdiction directed)

on 7/23/2020 at 6:42 PM

From: Gregg Lutz

User Posts: 330 - Intermediate User

Download Attachment IRR CLM900 Voting Results.pdf 69.16 kB 20 downloads

Voting for IRR CLM900 completed on Wednesday, July 22, 2020. The proposed resolution was APPROVED along with the implementation timeline.

A total of 30 responses were received consisting of 24 Yes Votes, 1 No Vote and 5 Abstentions. Per the requirements of the IRR process, a two-thirds majority is required for an IRR to be considered approved. The outcome of this vote exceeded the two-thirds requirement with 96% in favor of the proposed resolution. A detailed report of the voting results for CLM900 is attached.

on 7/1/2020 at 4:20 PM

From: Gregg Lutz

User Posts: 330 - Intermediate User

The voting period for this IRR has begun and will extend through 07/22/20. A new ballot for this IRR was sent to the voting body via email on 07/01/20. The voting body is comprised of current IAIABC jurisdictional and EDI members in good standing. Each eligible organization is allowed one vote per IRR. It is the responsibility of the designated voter (or the alternate, if the designated voter is not available) to discuss the issue up for vote with all stakeholders within their organization and vote accordingly.

on 6/10/2020 at 3:38 PM

From: Candace Gray

User Posts: 18 - New User

Download Attachment IRR 900 workgroup_20200527Meeting.docx 45.52 kB 11 downloads

Thank you Gregg.  As all are aware, we had some updates to the verbiage following our last Claims Committee meeting.  I've attached the updated notes to go along with the revised proposed resolution. 


Gregg Lutz wrote:

14 Day Review has been extended through June 30, 2020 due to a revised final proposed resolution (see below).

Revised Final Proposed Resolution: Add a new data element to capture Benefit Change Reason Code (DNXXXX).

     

IRR CLM900 - BENEFIT CHANGE REASON CODE (DNXXXX)

Definition: A code reported at the Claim level identifying the reason the Benefit Type Code or Net Weekly Amount has changed.  This is not at the Benefit segment level.


     

DP Rule:  This DN can only be required/reported on a SROI MTC CB - Change in Benefit Type or CA - Change in Benefit Amount.  It does not apply to any other SROI MTC's.  This should not carry over to future transactions.  It is recommended that the jurisdiction should have a regulatory reason for requiring this DN due to the implications of work flow for Claim Administrators and should be outlined in the jurisdiction's Trading Partner Tables.  The data element cannot be Mandatory if the reason for the change in the Net Weekly Amount or Benefit Type Code can be determined by another Data Element elsewhere in the standard. 

Values: (To be determined by Systems Committee)


     

? = Independent Medical Exam (IME) or Claim Administrator Consultant


     

? = Employee Treating Physician medical report


     

? = Recalculation of Net Weekly Amount based on Wage Statement


     

? = Jurisdiction Directed


     

? = Stipulated or negotiated Net Weekly Amount (not jurisdiction directed)




on 6/10/2020 at 2:14 PM

From: Gregg Lutz

User Posts: 330 - Intermediate User

14 Day Review has been extended through June 30, 2020 due to a revised final proposed resolution (see below).

Revised Final Proposed Resolution: Add a new data element to capture Benefit Change Reason Code (DNXXXX).

     

IRR CLM900 - BENEFIT CHANGE REASON CODE (DNXXXX)

Definition: A code reported at the Claim level identifying the reason the Benefit Type Code or Net Weekly Amount has changed.  This is not at the Benefit segment level.

     

DP Rule:  This DN can only be required/reported on a SROI MTC CB - Change in Benefit Type or CA - Change in Benefit Amount.  It does not apply to any other SROI MTC's.  This should not carry over to future transactions.  It is recommended that the jurisdiction should have a regulatory reason for requiring this DN due to the implications of work flow for Claim Administrators and should be outlined in the jurisdiction's Trading Partner Tables.  The data element cannot be Mandatory if the reason for the change in the Net Weekly Amount or Benefit Type Code can be determined by another Data Element elsewhere in the standard. 

Values: (To be determined by Systems Committee)

     

? = Independent Medical Exam (IME) or Claim Administrator Consultant

     

? = Employee Treating Physician medical report

     

? = Recalculation of Net Weekly Amount based on Wage Statement

     

? = Jurisdiction Directed

     

? = Stipulated or negotiated Net Weekly Amount (not jurisdiction directed)