HIPAA HIPAA Transaction Standards and Code Sets 2

Question 1

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

Accepted Answer

837I

Answer

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

Question 2

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

Accepted Answer

CDT

Answer

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

Question 3

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

Accepted Answer

CMS

Answer

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

Question 4

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

Accepted Answer

835

Answer

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

Question 5

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

Accepted Answer

National Drug Codes (NDC)

Answer

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

HIPAA - Health Insurance Portability and Accountability Act Practice Test