Starting with the implementation of HIPAA* version 5010, Blue Cross and Blue Shield of Kansas will require the presence of a diagnosis code describing the patient's reason for visit on ALL outpatient claims.  This will effect the information you provide in loop "2300 HI – Patient Reason for Visit" in the 837I electronic transaction or form locator 70 on the UB-04 claim form.

70 PATIENT REASON DX

a

b

c

PATIENT'S REASON FOR VISIT - REQUIRED FOR ALL OUTPATIENT VISIT
Enter the appropriate diagnosis code describing the patient's reason for the visit at the time of the outpatient encounter

Providers may need to share this information with their vendor to insure that claims are submitted with this information.  Outpatient claims that do not include a patient's reason for visit once version 5010 is implemented will be rejected and returned to the provider.

The new 5010 version will replace the current version 4010A1 January 1, 2012.  Providers wanting to implement version 5010 prior to the required effective date can do so as early as Feb 19, 2011, when BCBSKS will be in full compliance and ready to accept production claims.  Because BCBSKS will be in full compliance by February 19, 2011, we will accept both version 4010A1 and version 5010 until January 1, 2012.  All covered entities have to be fully compliant on January 1, 2012.

BCBSKS testing and production timelines for 5010 are outlined below. The testing date is the time when Trading Partners can begin testing the receipt of the transaction by BCBSKS.  The Production date is the actual date BCBSKS will be prepared to accept and process the 5010 transactions as defined by the implementation guide standards.

If you have questions about version 5010, please contact your vendor, our EDI department (1-800-472-6481), or your provider consultant.

*Health Insurance Portability and Accountability Act (HIPAA)