Health Care Insurance Report Type Codes

$179 / year

Healthcare Insurance Report Type Codes is a dataset that defines the type of report being described in an insurance claim and are transmitted in 005010X306, loop 2300, REF03. This dataset also contains information on the different report type codes and their descriptions, start and modified dates, and the status of each code whether active, to be deactivated or deactivated.

Complexity

Healthcare Insurance Report Type Codes are transmitted in 005010X306, loop 2300, REF03. They define the type of report being described. The pertinent ASC X12 documentation is available in ASC X12 Stores.

The Centers for Medicare & Medicaid Services (CMS) maintain and annually update a List of Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) Codes (Code List), which identifies all the items and services included within certain DHS categories. CMS updates the Code List to conform the list to the most recent publications of CPT and HCPCS and to account for changes in Medicare coverage and payment policies. The updated Code List is published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule. That rule is usually published in November and generally becomes effective January 1 of the following year. In addition, we may publish other rules or correction notices that may change the Code List. CMS posts any changes to the Code List on its webpage as soon as possible after publication in the Federal Register.

The DHS categories defined by the Code List are:
– Clinical laboratory services;
– Physical therapy services, occupational therapy services, outpatient speech-language pathology services;
– Radiology and certain other imaging services; and
– Radiation therapy services and supplies.

**NOTE**: The following DHS categories are defined at 42 CFR §411.351 without reference to the Code List:
– Durable medical equipment and supplies;
– Parenteral and enteral nutrients, equipment and supplies;
– Prosthetics, orthotics, and prosthetic devices and supplies;
– Home health services;
– Outpatient prescription drugs; and
– Inpatient and outpatient hospital services.

Date Created

2013-10-01

Last Modified

2017-11-01

Version

2017-11-01

Update Frequency

Irregular

Temporal Coverage

2013 to 2017

Spatial Coverage

United States

Source

John Snow Labs; Centers of Medicare and Medicaid Services (CMS);

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Report Type Codes, Exchange-related Report Type codes, Health Insurance Exchange Code Lists, ASC X12 Documentation, Code Checker, Health Insurance, Insurance Code, Insurance Electronic Transactions

Other Titles

Health Insurance Portability and Accountability Act (HIPAA) Standard Electronic Transactions, Medicare Appropriate Report Type Codes, Health Insurance Exchange-related Report Type codes, Report Type Codes for CMS shop and Individual market, CMS Report Type Codes, CMS Exchange-related Report Type codes, Statement on Standards for Attestation Engagements (SSAE) Reports

NameDescriptionTypeConstraints
CodeReport Type Codesstringunique : 1 required : 1
DescriptionDescription for each Report Type Codestringunique : 1 required : 1
Start_DateDate the Report Type Code started usagedaterequired : 1
Last_ModifiedDate the Report Type Code was changed/modifieddate-
Stop_DateDate the Report Type Code was deactivated/stoppeddate-
StatusCode update whether Active, To be Deactivated or Deactivatedstring-
NotesExplanation of the coverage for each Report Type Codestringrequired : 1
CodeDescriptionStart_DateLast_ModifiedStop_DateStatusNotes
INVOICERPTReferences an Invoice number related to the Exchange Payment Type Code in the 2300 Loop2013-10-012015-11-01ActiveCMS Individual Market Only
ISSUERIDRPTReferences an Issuer (5-digit) HIOS ID number related to the Exchange Payment Type Code in the 2300 Loop2015-11-01ActiveCMS Individual Market Only
PAYMENTTRANSACTIONIDThis will be the Payment Transaction ID for the initial payment ID if this is an initial payment.2014-11-012015-11-01ActiveCMS SHOP Market Only
BALRPTThe report type code that corresponds to BAL Payment Type code to provide additional details for the transaction.2015-01-11ActiveCMS All Programs and Relevant Markets
INFORPTThe report type code that corresponds to any Payment Type code to provide additional details for the transaction.2016-10-18ActiveCMS All Programs and Relevant Markets
SHOPUFRPTThe number included in the document control number references a unique trace number (TRN02) from a corresponding SHOP HIX 820 transaction.2015-11-01CMS Individual Market Only
REVMADJRPTThe number included in the document control number references a unique trace number from a prior month HIX 820 where the manual adjustment first occurred.2013-10-012015-11-012015-11-01DeactivatedCMS Individual Market Only
MADJRPTThe number included in the document control number references a unique trace number that may be included on a future HIX 820 if the manual adjustment is reversible.2013-10-012015-11-012015-11-01DeactivatedCMS Individual Market Only
AFFRPTReferences an affiliate payee ID and HIX 820 EFT Trace Number (TRN02) that will allow the payee to identify the affiliate related to the Exchange Payment Type Code in the 2300 Loop.2013-10-012015-11-012015-05-01DeactivatedCMS Individual Market Only
INFORPTThe report type code that corresponds to any Payment Type code to provide additional details for the transaction.2016-10-18ActiveCMS All Programs and Relevant Markets