October 20, 2021
Beginning 09/21/2021 ASK will validate diagnosis code pointer usage to ensure the correct number of pointers are used based on the number of diagnosis codes submitted on a claim. If the number of pointers used does not align with the number of diagnosis codes submitted the claim will be rejected.
Example: if a claim is sent with 2 diagnosis codes and 3 diagnosis code pointers it will reject.
Note: There can be up to 12 diagnosis codes submitted per claim, however each service line only allows up to 4 diagnosis code pointers. (Reference: TR3) ASK is not requiring a pointer for each diagnosis code. ASK is validating that if a pointer is sent that there is a diagnosis code to go with it.
Segment and Elements Impacted: SV107-01, SV107-02, SV107-03, SV107-04