Pain Management Standard v3.1

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UHIN Pain Management Standard is compatible with all HIPAA requirements.

Purpose: The purpose of this Standard is to provide a uniform method of submitting pain management claims/encounters, pre-authorizations and notifications.

Applicability: This Standard applies to all pain management claims. Pain management is defined according to the American Society of Anesthesiologists (ASA) guidelines. Pain management includes only non-time based procedures.

Detail:

  1. Electronic Pain Management Claim/Encounters will use the ASC X12 005010X222A1 837 Professional Implementation Guide.
  2. Paper Pain Management Claim/Encounters will use the CMS 1500 (version 02/12) claim form.
  3. Pain Management claims/encounters, pre-authorizations and notifications shall use current Healthcare Common Procedural Coding Systems (HCPCS) for billing codes as described on CMS’ official HCPCS website at https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html
  4. Payers request the elimination of paper attachments with a submitted electronic/paper claim or encounter.

 

 

 

Original

V3.0

V3.1

 

ORIGINATION DATE

08/18/1999

10/26/2010

5/13/2015

 

APPROVAL DATE

09/09/2002

02/02/2011

8/5/2015

 

EFFECTIVE DATE

10/09/2002

03/02/2011

9/5/2015

 

 

 

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