APCD 837 ER Claims: Care Settings Updated Based on Revenue Codes

There are observed claims which have an ER revenue code on the claim, but which have a point of sale or type of bill code that is assigned a “Hospital Outpatient” care setting.

These ER Revenue codes are: 0450, 0451, 0452, 0456, 0459, 0981.

This is the standard set of revenue codes used throughout state data sets when setting the ‘ER Flag’. The care setting that comes on the claim will be overwritten to Emergency Room Hospital, along with the corresponding care setting code of 23.

Contact your Customer Success Manager for more information.


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