NUCC Approves Use of Condition Code DR for Professional Claims for COVID-19 Related Claims, Effective Immediately
March 24, 2020
The NUCC has approved the use of Condition Code “DR – Disaster Related” effective immediately for COVID-19 related claims on the 1500 Claim Form and in the 837 Professional. The codes available for use for COVID-19 related claims are:
- Condition Code DR - Disaster related; Reported at the claim level in Item Number 10d
- Modifier CR - Catastrophe/disaster related; Reported at the service line level in Item Number 24D
The Centers for Medicare & Medicaid Services (CMS) recently released MLN Matters SE20011 on the use of Condition Code DR and Modifier CR for COVID-19 related Medicare claims. For Medicare, Condition Code DR is reported only in the institutional claim (electronic ASC X12 837I or paper UB-04). The NUCC has approved the use of Condition Code DR in the professional claim (electronic ASC X12 837P or paper 1500) due to the business need by other payers to identify COVID-19 related claims, as it can be used to trigger internal payer steps or processing of claims (e.g. a different routing of the claim for processing).
The complete list of Condition Codes available for use in the professional claim is available on the Condition Codes page under the Code Sets tab.
New Provider Characteristics Code for COVID-19 Testing, Effective 4/1/20
March 23, 2020
The NUCC has released a new Health Care Provider Characteristics code to identify providers offering COVID-19 testing. The new code will go into effect out-of-cycle on April 1, 2020. The new code is "6J - This provider offers testing for COVID-19."
The complete code set is available under the "Code Sets" tab.
January 2020 Taxonomy Code Set Update Released
January 2, 2020
The NUCC has released the semi-annual update to the Health Care Provider Taxonomy code set, which will go into effect on April 1, 2020. The complete code set is available under the "Code Sets" tab. The PDF download version of the code set is also available there.
When reviewing the Health Care Provider Taxonomy code set online, revisions made since the last release can be identified by the color code; modified items are orange.
2019 Annual 1500 Instruction Manual Released
June 28, 2019
The NUCC has released its annual, updated version of its 1500 Health Insurance Claim Form Reference Instruction Manual. The updated instruction manual, Version 7.0 7/19, goes into effect immediately and is available under the 1500 Claim Form tab.
No changes were made since the Version 6.0 7/18 manual was released. A change log is available on the 1500 Instructions page and states that no changes were made to the manual during the previous year. Any interim changes, clarifications, or corrections to the instructions following this release will be posted on the NUCC website.
Do NOT email, fax, or mail completed 1500 Claim Forms to the NUCC. The NUCC does not process claims. Send completed forms to the appropriate payer.
Questions about the DSMO Process?
The Designated Standards Maintenance Organizations (DSMO) have created a presentation "Understanding the HIPAA Processes" to provide information on the HIPAA transactions, code sets, and operating rules processes under HIPAA. The presentation was developed to satisfy an industry need to have in one concise document the process of how to request changes to HIPAA mandated standards.
The presentation is available here: DSMO: Understanding the HIPAA Process
The DSMO includes three American National Standards Institute (ANSI) Accredited standard development organizations ‐ Accredited Standards Committee (ASC) X12, Health Level Seven (HL7) International, and the National Council for Prescription Drug Programs (NCPDP), and three data content organizations ‐ the American Dental Association (ADA) Dental Content Committee (DeCC), National Uniform Billing Committee (NUBC), and National Uniform Claim Committee (NUCC). The DSMO reviews change requests to the HIPAA designated standards and requests for new standards and code sets to be adopted.
Resources for Implementing the 02/12 1500 Claim Form
Payers may begin accepting the 02/12 1500 Claim Form as of January 6, 2014. The following resources will assist your organization in implementing the revised form:
- Understanding the Changes to the 0212 1500 Claim Form presentation
- Updating to the 0212 1500 Claim Form
Submitters of the form should follow up with their specific payer(s) regarding their transition timeline information.
Who Are We?
The National Uniform Claim Committee (NUCC) is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995. The committee was created to develop a standardized data set for use by the non-institutional health care community to transmit claim and encounter information to and from all third-party payers. It is chaired by the American Medical Association (AMA), with the Centers for Medicare and Medicaid Services (CMS) as a critical partner. The committee is a diverse group of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.
The NUCC was formally named in the administrative simplification section of the HIPAA of 1996 as one of the organizations to be consulted by the American National Standards Institute's accredited SDOs and the Secretary of HHS as they develop, adopt, or modify national standards for health care transactions. As such, the NUCC is intended to have an authoritative voice regarding national standard content and data definitions for non-institutional health care claims in the United States. The NUCC's recommendations in this area are explicitly designed to complement and expedite the work of the Accredited Standards Committee Electronic Data Interchange (ASC X12N) in complying with the provisions of P.L. 104-191.
The NUCC is comprised of the key parties affected by health care electronic data interchange (EDI) - those at either end of a health care transaction, generally payers and providers. Criteria for membership include a national scope and representation of a unique constituency affected by health care EDI, with an emphasis on maintaining or enhancing the provider/payer balance. Each committee member is intended to represent the perspective of the sponsoring organization and the applicable constituency. Representatives are responsible for communicating information between the committee and the group(s) they represent.