Useful Advices - Business

In our previous installments of medical billing and the electronic transmission of claims, we touched on the topic of trailer records and th

According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product

e importance of record hierarchy. In this installment we're going to take a detailed look at the claim level trailer record, which is the X

; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

Examples of combination products may in

0 record.

The XA0 record must be transmitted with each individual patient claim. If a patient has five items, or FA0 records, that have to

lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.

be billed, then the XA0 record must give the totals for all those FA0 records, including totals for all other records attached to each indiv

here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe

dual patient. Let's go over each of the individual fields in the XA0 record.

XA0 field 1, positions 1 - 3, is the record type. This field

d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.

Combination pro

must be filled with XA0 or the claim will be denied. Also, this record must come after all C, D, E, F, G and H records for that particular

ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc

atient.

XA0 field 2, positions 4 - 5, are reserved and not supported. This is to hold consistent with the mapping for the CMNs which use t

easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi

ese positions for the sequence number of the records.

XA0 field 3, positions 6 - 22, is the patient ID. This must be the same patient ID t

nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically

at is transmitted in the CA0 record and all subsequent records that transmit patient information. If this number doesn't match, the claim w

and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ

ll be denied.

XA0 field 4, positions 23 - 24, is the CXX record count. This is the total number of C records that are being transmitted fo

ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi

that particular patient. In most claims, this is just the CA0 record, but if the CB0 and CB1 records are transmitted, then they have to be

ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

Following aspects would a

included in this count.

XA0 field 5, positions 25 - 26, is the DXX record count. This is the total number of D records, or carrier record

dd to the challenges in developing combination products:

Which markets to tap where the combination products can do fairly well?
Which combination prod

being transmitted. In most cases, a patient has only primary insurance and only one record is sent. However, if the patient has supplemen

cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin

ary insurance, those records are also included in this count.

XA0 field 6, positions 27 - 28, is the EXX record count. This is the total n

tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen

mber of E records, or facility records being transmitted. Because there can be a number of facilities involved with any particular claim, t

t?

As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel

is number can be just about anything.

XA0 field 7, positions 29 - 30, is the FXX record count. This is the total number of F records, or l

ping new procedures for reviewing their safety, efficacy and quality.

Professional from academic institutions, pharmaceutical industries, health care indust

ne item records being transmitted. This is usually the greatest record count in a claim file for a patient.

XA0 field 8, positions 31 - 32

y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products

is the GXX record count. This is the total number of G records, or CMNs being transmitted. Because a patient can have a number of items a

.

As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de

d because each item can have a required CMN, this field can also be one of the higher total fields in the claim file.

In our next installme

elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.

Companies that provide selfless information through particip

t of medical billing of claims via electronic transmission, we'll continue with our review of the XA0 record, picking up with field number 9

tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products

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Useful Advices - Medical Billing - XA0 Record Fields 1 Through 8

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