Texas Medicaid is implementing a Cost avoidance program on Feb 23,2013. At that time they will begin requiring hospice, nursing facility and ICF providers to provide additional information on a 5010 claim when there are other insurances involved.
Their 5010 Companion Guide has been update with the following requirement for the K3 segment.
Positions 1-8 of K301 if Subscriber DOB is present. If the Subscriber DOB is not present, fill K301 with spaces. This is a mandatory field if
conveying Other Payer Information in the 2320 loop. The amount of Other Insurance segments conveyed in the 2320 loop(s) must match the number of K3 segments submitted in the 2300 loop.
Example: K3*19991215
The TR3 indicates that X12 had to be contacted and they approved that no other method exists for capturing this information prior to using this segment.
Was that step completed? Are they eligible to use the K3 segment and still have compliant claims?
Subscriber DOB is already reported in Loop 2010BA DMG.
No. The K3 segment cannot be used without the express approval of X12N. X12N has not approved the K3 for this usage.
Texas Medicaid must submit a request through this portal identifying their legislative requirements.