Health Care Decision Reason Codes are used to indicate the primary reason for the certification action code assigned as part of a health care services review.
Health Care Decision Reason Codes are supported in the Health Care Services Review Response Implementation Guide (version 4050). The HCR03 data element references this code source in version 4050 and later.
Denials are handled thorough the use of the HCR03 using the Health Care Decision Reason Code List.
Health Care Decision Reason Codes are not to be used for missing or rejected information. The invalid codes will be handled using the AAA segment and the 901 data element list.
The Claim Adjustment Status Code maintenance committee meets on the Sunday of each ASC X12 trimester meeting. The meetings are held three times a year:
The Claim Adjustment Status Code Maintenance Committee
The Claim Adjustment Status Code Maintenance Committee Meeting Minutes
It is recommended that individuals pursuing a new code or changes to a code message first contact their
industry representative on the committee or another committee member by email to discuss their request prior to submitting the form.
By doing so, this may facilitate their request by allowing someone familiar with the approval process to discuss an alternate solution (if appropriate) for their need, or enabling that committee member to obtain additional background information which could help with the request.
Requestors are not required to contact a committee member prior to submitting their request, but they are strongly encouraged to do so. This process allows the committee to more fully understand and discuss requests and have more time at the meeting to do so.
Use the
On-Line Conference to participate in the discussions concerning code maintenance.
