UHIN Telehealth Standard is compatible with all ASC X12N HIPAA requirements as well as industry recommendations and guidance.
The purpose of UHIN Telehealth Standard is to provide a uniform standard of billing for health care claims/encounter delivered via telehealth.
DEFINITIONS:
Connectivity methods:
- Synchronous: "Synchronous interaction" means real-time communication through interactive technology that enables a provider at a distant site and a patient at an originating site to interact simultaneously through two-way audio and video transmission.
- A-Synchronous: "Asynchronous store and forward transfer" means the transmission of a patient's health care information from an originating site to a provider at a distant site. Transmission of recorded health data through an electronic communication system to a practitioner (usually a specialist i.e. radiologist).
- Store and forward telehealth – is the electronic transmission of health data and digitized images. The exchange of data and digitized images (i.e. teleradiology), and is done between the referring provider and consulting provider.
- Remote monitoring: Patient remote monitoring where data are sent to a provider.
These connectivity methods are technology agnostic (undefined).
Delivery Exchanges: include exchanges from:
- Patient to Provider (Direct-To-Consumer)
- Provider to Provider
- Provider to more than one patient (group/peer support sessions)
The exchanges may use one or more of the connectivity methods described above for health care services
Types of Services/Care may include:
- clinical care;
- health education;
- health administration;
- home health; or facilitation of self-managed care and caregiver support; and provided by a provider to a patient through a method of communication that: uses asynchronous store and forward transfer; or (B) uses synchronous interaction
Place of Service (Originating site/Patient Location):
- "Distant site" means the physical location of a provider delivering telemedicine services.
- "Originating site" means the physical location of a patient receiving telemedicine services.
Billing/Reporting Requirements:
- The billing provider will bill using customary medical billing codes (ex. HCPCS/CPT), one of the following modifiers.
- GT: Via interactive audio and video telecommunication systems
- GQ: Via a-synchronous telecommunication systems
- 95: Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System
- Billing for services electronically are accomplished by using the most current version of the ASC X12 HIPAA transaction for Healthcare Claim.
- When the billing using form CMS 1500, the following are the box requirements for the originating and distance providers:
Box 24B - Place of Service must be appropriate to where services are rendered.
For Distance Billing Provider: Place of Service code 02 must be used.
For Originating billing provider Place of Service must be the appropriate code required and allowed by the payer, without a telehealth modifier.
X12 Professional Claim Mapping: 2400 SV105
Box 24D: Procedure, Services or Supplies require codes from the current nationally approved procedure code list, applicable to the service and allowed by the payer.
X12 Professional Claim Mapping: 2400 SV01-2 (proc code) and SV101-3 -4, -5, -6 (Modifiers)
Box 24J: Rendering Provider ID# requires the servicing provider National Provider Identifier (NPI).
X12 Professional Claim Mapping: 2420A NM108 (Qualifier) NM109 (NPI)
Box 25: Federal Tax ID is required for the billing provider.
X12 map: 2010AA REF02
Box 33 Billing Provider Info & phone requires the address of the billing provider.
X12 Professional Claim Mapping:: Name: 2010AA NM103, NM104, NM105, NM107
Address: 2010AA/AB N301, N401, N402, N403
Phone Number: 10AA/AB PER04
All other CMS1500 form requirements can be found in the CMS 1500 Paper Claim Form Standard.
Implementation Issues:
- Clearinghouses, payers and providers must make necessary modifications to use approved modifiers in their systems.
- Providers must be aware of any requirements regarding Originating Provider billing. Not all payers will provide benefits for originating providers.
- Payers that pay for Telehealth services will assist in educating the provider community about this UHIN Standard and the specific benefits covered by the payer.
History: (MM/DD/YY)
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Original |
A1 |
A2 |
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ORIGINATION DATE |
10/14/98 |
03/03 |
10/2016 |
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APPROVAL DATE |
03/16/98 |
08/13/03 |
11/1/2017 |
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EFFECTIVE DATE |
04/16/99 |
09/13/03 |
12/1/2017 |
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* A = Amendment
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