NRPM: Standards for Electronic Transactions. ADDENDUM 3--COORDINATION OF BENEFITS

05/07/1998

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A. Professional Claim Coordination of Benefits

The transaction selected for the professional claim coordination of benefits is ASC X12N 837 - Health Care Claim: Professional (004010X098).

1. Implementation Guide and Source

The source of the implementation guide for the professional claim coordination of benefits transaction set is: Washington Publishing Company, 806 W. Diamond Ave., Suite 400, Gaithersburg, MD, 20878, Telephone 301-590-9337, FAX: 301-869-9460. The web site address is http://www.wpc-edi.com/hipaa/

2. Data Elements

Data elements are found in addendum 1, B.2.

B. Institutional Claim Coordination of Benefits

The transaction selected for the institutional claim coordination of benefits is ASC X12N 837 - Health Care Claim: Institutional (004010X096)

1. Implementation Guide and Source

The source of the implementation guide for the institutional claim coordination of benefits transaction set is: Washington Publishing Company, 806 W. Diamond Ave., Suite 400, Gaithersburg, MD, 20878, Telephone 301-590-9337, FAX: 301-869-9460. The web site address is http://www.wpc-edi.com/hipaa/

2. Data Elements

Data elements are found in Addendum 1, C.2.

C. Dental Claim Coordination of Benefits

The transaction selected for the dental claim coordination of benefits is ASC X12N 837 - Health Care Claim: Dental (004010X097).

1. Implementation Guide and Source

The source of implementation guide for the dental claim coordination of benefits transaction set is: Washington Publishing Company, 806 W. Diamond Ave., Suite 400, Gaithersburg, MD, 20878, Telephone 301-590-9337, FAX: 301-869-9460. The web site address is http://www.wpc-edi.com/hipaa/

2. Data Elements

See Addendum 1, D.2.

D. Retail Drug Claim Coordination of Benefits

The transactions selected for retail drug coordination of benefits is NCPDP Telecommunications Standard Format version 3.2 and the equivalent NCPDP Batch Standard Version 1.0.

1. Implementation Guide and Source

The source of implementation guide for the retail drug claim coordination of benefits transaction set is: National Council for Prescription Drug Programs, 4201 North 24th Street, Suite 365, Phoenix, AZ, 85016, Telephone 602-957-9105, FAX 602-955-0749. The web site address is http://www.ncpdp.org

2. Data Elements

See Addendum 1, A.2.