Required “Unknown” Values Standard v3

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UHIN Required Unknown Values Standard is compatible with all HIPAA requirements.

Purpose:  This UHIN Standard is intended to provide guidance for the use of common data values that can be used within the HIPAA transactions when a required data element is not known by the provider, payer or sponsor for patients, enrollees, as well as all other people associated with these transactions.   These data values should only be used when the data is truly not available or known.  These values are not to be used to replace known data.

Applicability: This UHIN Standard applies to all HIPAA transactions as well as transactions that have been approved by the Utah Health Information Network Board of Directors for implementation.

Basic Concepts:

The required data elements that have been identified for unknown values are:

ELEMENT

VALUE TO USE

Service Date

 

Eligibility Requests (270)

Use the current days date

Paper claims

Payers determine what to use

Adjudication Date

 

Remittance Advice (835)

January 01, 1901

Claim Status (276)

Other Claim Dates (See Appendix A)

January 01, 1901

Subscriber Birth Date

Patient Birth Date

January 01, 1901

Tax Id

Send the Tax ID qualifier[1]

 with Tax ID number of 999999999.

Street address

UNKNOWN

 

City

Other Payer ID in 837

Individual Names

 

Detail:

Implementation:

  1. Every reasonable effort to obtain the actual data value should be attempted before these values are put into the transaction.
  2. UHIN recommends that UHIN members begin using and accepting these values in production for all HIPAA and UHIN approved transactions.

Implementation Date:

 

History: (MM/DD/YY)

 

Original

V3

A 1

A 2

 

ORIGINATION DATE

08/07/03

09/23/10

 

 

 

APPROVAL DATE

5/12/04

02/02/2011

 

 

 

EFFECTIVE DATE

6/12/04

03/02/2011

 

 

 

* A = Amendment

 

 

 

 

APPENDIX A

OTHER CLAIM DATES


CLAIM LEVEL DATES

Initial Treatment

Onset of Current Illness/Symptom

Acute Manifestation

Accident

Last Menstrual Period

Last X-ray

Hearing and Vision Prescription Date

Disability Begin

Disability End

Last Worked

Authorized Return to Work

Admission

Discharge

Assumed and Relinquished Care Dates

Appliance Placement

Repricer Received Date

Last Seen Date

Property and Casualty Date First Contact

Statement

 

LINE LEVEL DATES

Certification Revision Date

Begin Therapy Date

Last Certification Date

Test

Shipped

Onset of Current Symptom/Illness

Last X-ray

Initial Treatment

Appliance Placement

Last Seen Date

Prescription Date

Prior Placement

Replacement

Treatment Start

Treatment Completion

 

[1] If in any of the TR3’s a loop is used where the segment is required, the Tax ID element is required (situational or otherwise), and the data is unknown, then use the recommended value.

 

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