OAR 436-160-0410: Electronic Medical Bill Data Transmission and Format Requirements

(1) The transmission data and format requirements are included in the IAIABC EDI Implementation Guide for Medical Bill Payment Records, Release 2.0 (Feb 1, 2014), and Appendices A and B of these rules. Oregon-specific information can be found on the division’s Electronic Data EDI webpage: http://wed.oregon.gov/insurer/edi/Pages/medical-bill-data.aspx. (2) Data elements are listed in Appendices A and B: (a) Appendix A shows all medical bill data elements accepted by EDI in Oregon, and whether the data element is “Fatal Technical” (F), “Mandatory” (M), “Mandatory Conditional” (MC), “If Applicable/Available with Item Reject if Invalid” (AR), or “If Applicable/Available with Item Accept if Invalid” (AA) for each transaction type. (b) Appendix B lists mandatory conditional data elements that are mandatory under specific conditions. (3) Unless otherwise provided in these rules, the data elements must have the meaning provided in the IAIABC EDI Implementation Guide for Medical Bill Payment Records, Release 2.0, dated Feb. 1, 2014, Section 2; Health Care Claim (837). (4) Transactions will be rejected if “Fatal Technical,” “Mandatory,” or “Mandatory Conditional” data elements are omitted, or include invalid values. (5) Transactions will be rejected if “If Applicable/Available with Item Reject if Invalid” data elements include invalid values. (6) Invalid “If Applicable/Available with Item Accept if Invalid” data elements will be ignored if they are included in a transaction. [ED. NOTE: Appendices are available from the agency.] [ED. NOTE: To view attachments referenced in rule text, click here to view rule.]