New HIPAA-compliant Codes

Codes Must be Used or Claims Will be Rejected

As part of Humana’s efforts to ensure complete compliance with the Health Insurance Portability and Accountability Act (HIPAA) transaction and code sets requirements, claims submitted after Oct. 16, 2003, that contain invalid HIPAA codes will be rejected. To enable Humana to standardize its code-verification and payment processes, the requirement will apply to both paper and electronically submitted claims.

Physicians, other health care providers and their office staff should note that the new requirement applies to all claim codes, which means that providers whose contracts include special codes for certain services or arrangements must now default to the HIPAA-valid codes to ensure timely claims processing and reimbursement. To help you avoid claims rejection after October 16, Humana’s contracting team has notified providers who previously submitted claims that contained HIPAA-invalid codes. Providers who haven’t been contacted or who have questions regarding certain codes are encouraged to call their Humana provider contracting representative.

The new HIPAA standard code sets are as follows:

• Current Procedural Terminology (CPT) codes, as determined by the American Medical Association,
• Healthcare Common Procedure Coding System (HCPCS) codes, determined by the Centers for Medicare and Medicaid Services (CMS),
• Diagnostic Related Group (DRG) codes, as determined by CMS,
• Revenue codes, as determined by the National Uniform Billing Committee and
• Current Dental Terminology (CDT) codes, as determined by the American Dental Association.

To view or download a complete list of HIPAA code sets, go to http://cms.hhs.gov/hipaa/hipaa2/regulations/transactions/default.asp

Back to top