US · guidance
CMS Pub. 100-04, ch. 24, § 60.2.1
Claim Key Shop and Optical Character Recognition
(OCR)/Image Character Recognition (ICR) Mapping to ASC X12 Based
Flat File
(Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13)
A/B MAC and DME MAC key shop operations, that do not output directly in the ASC
X12 837 claim or ASC X12-based flat file as output, must convert the initial output from
paper claims to the ASC X12-based flat file format or the ASC X12 837 claim prior to
transmission to their data center. When the ASC X12-based flat file is the output the
REF01 segment/element (found prior to the ST segment) shall contain a value of “+PR”
and REF02 shall contain a value of “K” (key shop) or “O” (OCR/ICR).
A/B MACs (B) and DME MACs who support telephone claim submission shall convert
the output to the ASC X12-based flat file. The value in REF02 shall contain a “T”
(teleclaim).
The DME MAC shared system shall apply implementation guide edits only to those
requirements that are applicable to both the HIPAA and the corresponding fields on the
paper claim. Implementation guide edits that are inappropriate for paper claims shall be
by-passed.
History
(Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3ae92635b473cbc76a8b63ce046dbdc3a35db7b43b28c36c1b6e2cb5e60255bc
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