RFI #
2771
Admitting Diagnosis Requirement for 837I claims for INTERMEDIATE CARE facilities
Description
Is the Admitting Diagnosis required on the 837I claims for Intermediate Care facilities, Bill Type 65X?
Scenario
A clearinghouse is asking a provider to not include the Admitting Diagnosis on their 837I claims. The provider is an Intermediate Care facility. Is the clearinghouse correct?
RFI Response
The Situational Rule (below) does not speak to individual Bill Type values and is more generic: Required when claim involves an inpatient admission. If not required by this implementation guide, do not send. Please see Section 1.12.6 in the 837I, which identifies that inpatient vs. outpatient is defined in the NUBC UB-04 Data Specifications Manual.
DOCUMENT ID
005010X233