Questions Submitted by the Public, by Date Posted to the Website. Relationship to HCFA 1500

11/02/2001

Will the printed HCFA-1500 form be revised to accommodate the HIPAA standard fields?

The issue is not just of theoretical importance but also practical because much of our EDI claims volume comes from practice management systems that produce print files (i.e., HCFA-1500 format print images designed to be sent to a printer) which are turned into electronic records. If this type of provider system does not have the ability to produce a revised electronic print image, then the provider will not be able to send standard electronic claims and will revert to old style, HCFA-1500 format paper claim submissions.


11/1/2000:

The data content of the paper professional claim (HCFA-1500) and the paper institutional claim (UB-92) are the responsibility of the National Uniform Claim Committee (NUCC) and the National Uniform Billing Committee (NUBC), respectively. Both of these organizations were named in HIPAA as entities with which the Secretary of Health and Human Services was to consult in developing the administrative simplification standards. Any recommendations that the Health Care Financing Administration (HCFA) may make with respect to these paper claims will be done with the concurrence of those Committees. HCFA is a member of both Committees.

The standards adopted in the Standards for Electronic Transactions Final Rule do not apply to paper forms. There are no plans to revise either of these forms prior to the implementation of the standards for electronic transactions. We certainly share your concern about the ability to convert the print images of these forms to electronic records that will be consistent with the Implementation Guides set forth for the electronic versions in the Standards for Electronic Transactions Final Rule.

The NUCC and the NUBC are very much aware of the concerns regarding data content gaps between the HCFA-1500 and UB-92 print images and the Implementation Guides for the ANSI X12N 837 4010 Professional Claim and the ANSI X12N 837 4010 Institutional Claim. Both Committees have asked the Association For Electronic Health Care Transactions (AFEHCT) to look into this issue. AFEHCT has agreed to do so, first by addressing the data gaps in the HCFA-1500 print image and, after completing that work, addressing those in the UB-92 print image.

AFEHCT has organized a task force, open to the public, called ASPIRE (Administrative Simplification Print Image Research Effort). ASPIRE is currently analyzing the HCFA-1500 data content gaps and will initiate a demonstration project to document how the gaps are filled. ASPIRE will publish "best practices" for filling gaps after the completion of the demonstration project. ASPIRE hopes to complete the work on the HCFA-1500 print image by the end of this year, and then will move on to doing the same kind of work for the UB-92 print image. Information about ASPIRE can be found on the AFEHCT website (http://www.afehct.org/).