Catherine Shelton and Larry Watkins worked on a project
through AFEHCT caled ASPIRE. There was a study completed that attacked
this exact problem. You may want to check www.afehct.org or contact
either Catherine or Larry.
-----Original Message-----
From:
Christopher J. Feahr, OD
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Sent: 3/4/02 5:41 PM
Subject: Re: 837 P Payer
Responsibility Sequence Number Code
Raj,
I'm not seeing any traffic in
"transactions" for a week, so possibly I
fell
off the list. But I'm curious to know how many
of these situations you
have encountered: required
data elements in the 837 that cannot be sent
to
a CH (or billing service, repricer, etc.) in a "1500"
format. I have
heard
that there are many fields that cannot be cross-walked between
the
CMS1500
and the 837, but I
have not actually combed through the standard looking
for them.
I have a real concern for the tens of thousands of small
providers with
systems only capable of producing
CMS1500 claims. "Marrying" a
clearinghouse would
not seem to be a HIPAA solution for these folks
unless
they have enough basic HIPAA-awareness in their local
OMS system to at
least extract all the Required and
Situational data elements from it.
If
the OMS vendors don't get their collective acts together, I don't
see
how
the doctors will be
able to comply with any of this.
(SBR01 may just ve the tip of an ugly iceberg)
-Chris
At 06:06 PM 2/25/02 -0500, Thuppanna, Raj wrote:
>I have a question about the field SBR01 - Payer
Responsibility Sequence
>Number Code in 837
(professional). This field indicates if the
destination
>payer is a primary, secondary
or tertiary.
>
>This is
a unique scenario where we (a re-pricer) get a HCFA claim on
paper
>and we forward the claim to
destination payer as 837 after re-pricing.
HCFA
>paper claim does not carry any information that indicates
if the payer
is
>primary,
secondary or tertiary. (I know that UB paper claim does carry
this
>information). But SBR01 (Payer
Responsibility Sequence Number Code) is
a
>required field on 837 professional.
>
>Is it ok for a re-pricer to convert
the paper claim to 837? If so how
do we
>derive SBR01 from information on HCFA paper claim?
>
>Any help is
appreciated
>
>Raj
Thuppanna
>770 444 4468
>
>
>
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request.
Christopher J. Feahr, OD
http://visiondatastandard.org
[EMAIL PROTECTED]
Cell/Pager:
707-529-2268
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