Through which electronic format are home infusion therapy claims submitted under HIPAA: X12N Professional or NCPDP Retail Pharmacy?
Home infusion therapy providers will submit their claims using only the ASC X12N 837 electronic claim format. This direction is provided by the Centers for Medicare & Medicaid Services (CMS) with two FAQs first posted in March of 2003 on CMS’s HIPAA web site and a subsequent letter written to NHIA. CMS’s direction applies to home infusion therapy claims submitted to all payers, including charges for drugs that are part of their claims.
