837 Health Care Claim: Institutional - Louisiana Medicaid

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06/30/2014 Health Care Claim: Institutional - 83712X, 13X, 14X, 18X, 21X, 71X, 72X,76X, 81X, 82X, 83X, 85X, 86X; 89X.For file extension 837I – HOM (Home Health) 32XCLM05-03 1325 Claim Frequency Type Code O ID 1/1LA Medicaid: Use the value 1 for an original claim, code 7 if the claim is anadjustment of a previous claim, or code 8 if a void of a previous claim.8
06/30/2014 Health Care Claim: Institutional - 837CL1Institutional Claim CodePos: 1400 Max: 1Detail - OptionalLoop: 2300 Elements: 3User Option (Usage): RequiredElement Summary:RefIdElement NameReqTypeMin/MaxCL1011315Admission Type CodeOID1/1LA Medicaid: Type of admission.CL102 1314Admission Source Code O ID 1/1LA Medicaid: Point of origin for admission.CL103 1352 Patient Status Code O ID 1/2LA Medicaid: Patient status as of statement through date.REFService AuthorizationException CodeUser Option (Usage): SituationalPos: 1800 Max: 1Detail - OptionalLoop: 2300 Elements: 2Element Summary:RefREF01Id128Element NameReference Identification QualifierLA Medicaid: Use the value 4N for this segment.ReqMTypeIDMin/Max2/3REF02 127 Reference Identification X AN 1/50LA Medicaid: Use the value 3 for this element when a Hospital isbilling for services associated with moderate to high levelemergency physician care.Moderate to high-level complexity corresponds to the level of carenoted in the definition of evaluation and management CPT codes99283, 99284 and99285.Use the value 1 if billing for services associated with low levelcomplexity which corresponds to the level of care noted in thedefinition of evaluation and management CPT codes 99281 and99282.The value in this REF02 segment corresponds to the same datathat would be placed in Form Locator 7 in the UB-04 billingdocument.9
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837 Health Care Claim: Institutional - Louisiana Medicaid

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