Received an 837 with a valid HIPPS code at date of service. The claim was adjudicated with that code. Payment process was executed after termination code's effective dates. When reporting payment on 835 the validator is rejecting the code because it is invalid at the 835 transaction's date, but the claim was adjudicated with that code which was valid at date of service.
Should the validator reject if code was valid at date of service?
HIPPS codes are a non-medical code set under HIPAA. The HIPPS code was valid when submitted on the 837 and was the code used in adjudication. Therefore, this is the code that must be returned in the 835.
It is not within X12N's purview to comment or interpret the actions of specific entities such as regulatory bodies, payers or providers.
Related RFIs: 1220, 1575, 2293, 2375