Attention: Trading Partners Diagnosis Code Limits on Claims

There are limits to the number of diagnosis codes that can be submitted on a claim. The limits for an 837 transaction are set by the Accredited Standards Committee (ASC) of the American National Standards Institute (ANSI), and are specific to claim type. NCTracks adheres to the ANSI standards for 5010 ASC X12 Electronic Data Interchange (EDI) transactions, which are mandated by HIPAA (Health Insurance Portability and Accountability Act). Similarly, NCTracks has a limit of 26 diagnosis codes that can be submitted on a claim keyed directly into the provider portal.

Some providers have recently attempted to submit claims that exceed the limit of diagnosis codes. The NCTracks provider portal will not allow more than 26 diagnosis codes to be keyed into a claim. If NCTracks receives an 837 I, D, or P transaction with too many diagnosis codes, the transaction is rejected for syntax/structure check. However, claim submission software and billing agents may be truncating 837 transactions so they do not exceed the limit for diagnosis codes.

The 5010 ASC X12 837 transaction limits on diagnosis codes are provided here for reference.

Regardless of the claim transmission method, NCTracks cannot accept claims with a number of diagnosis codes that exceeds the ANSI X12 standard. For additional information, refer to the Trading Partner Information page on the NCTracks provider portal.