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HIPAA Transaction Standards and Code Sets Flashcards

7 cards from real HIPAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 HIPAA Transaction Standards and Code Sets flashcards as text

  1. A hospital submits an inpatient stay claim electronically to a commercial payer. Which X12 transaction should it use?

    Answer: 837I

    The 837I is the institutional claim format used by hospitals and other facilities.

  2. A dental office needs to report a prophylaxis procedure on a claim. Which code set applies?

    Answer: CDT

    Current Dental Terminology (CDT), maintained by the ADA, is the HIPAA standard for dental services.

  3. Which organization maintains the ICD-10-PCS procedure code set?

    Answer: CMS

    CMS maintains ICD-10-PCS, while NCHS maintains ICD-10-CM.

  4. A payer sends a provider a detailed electronic explanation of how each claim line was paid or denied. Which transaction is this?

    Answer: 835

    The 835 is the health care claim payment/advice (electronic remittance advice) transaction.

  5. Under HIPAA, which code set is used to report drugs dispensed by a retail pharmacy?

    Answer: National Drug Codes (NDC)

    NDC is the HIPAA standard code set for retail pharmacy drug transactions.

  6. What is the HIPAA standard for retail pharmacy claims transmitted in real time?

    Answer: NCPDP Telecommunication Standard D.0

    Retail pharmacy drug claims use the NCPDP Telecommunication Standard Version D.0.

  7. When did ICD-10-CM and ICD-10-PCS become mandatory for HIPAA covered entities?

    Answer: October 1, 2015

    After two delays, the ICD-10 compliance date was October 1, 2015.

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