Illinois Administrative Code
Title 50 - INSURANCE
Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING
Section 2908.40 - Formats for Electronic Medical Bill Processing
Current through Register Vol. 48, No. 12, March 22, 2024
a) For electronic transactions, the following electronic medical bill processing standards shall be used:
The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, Health Care Claim: Professional (837), May 2006, ASC X12, 005010X222 (no later amendments or editions); and Type 3 Errata to Health Care Claim: Professional (837), June 2010, ASC X12, 005010X222A1 (no later amendments or editions);
The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, Health Care Claim Payment/Advice (835), April 2006, ASC X12N/005010X221 (no later amendments or editions); and Type 3 Errata to Health Care Claim Payment/Advice (835), June 2010, ASC X12/005010X221A1 (no later amendments or editions).
The use of the Health Claim Status Request and Response, 005010X213, shall be by mutual agreement.
b) Insurance carriers and health care providers may exchange electronic data in a nonprescribed format by mutual agreement. All data elements required pursuant to this Part shall be present in a mutually agreed upon format.
c) The implementation specifications for the ASC X12N and the ASC X12 Standards for Electronic Data Interchange may be obtained from the ASC X12, 7600 Leesburg Pike, Suite 430, Falls Church VA 22043; Telephone (703) 970-4480 and FAX (703) 970-4488. They are also available through the Internet at http://store.x12.org/. A fee is charged for all implementation specifications.
d) The implementation specifications for the retail pharmacy standards may be obtained from the National Council for Prescription Drug Programs, 9240 East Raintree Drive, Scottsdale AZ 85260; Telephone (480) 477-1000 and FAX (480) 767-1042. They are also available through the Internet at http://www.ncpdp.org. A fee is charged for all implementation specifications.
e) Nothing in this Section prohibits payers and health care providers, through mutual agreement, from using a direct data entry methodology for complying with these requirements, provided the methodology complies with the data content requirements of the adopted formats and this Part.