Jonathan and William,
Whoa....wait a minute. What on earth are you two quibbling about?????
Jonathan, you say:
" the worst case is surely not that payment is delayed - if an insurance
company's computer bounces or delays response to a claim status enquiry
until, say, the next working day when a member of staff can pick up the
phone to resolve the issue, then someone's emergency treatment or
surgery
might be delayed or postponed or a cheaper but less-effective procedure
carried out which might leave side-effects. This could in the worst
case
prove fatal or result in long-term disability. Then apart from the
ensuing litigation, there would also be the human trauma and tragedy."
A claim status query has NOTHING to do with an ELIGIBLITY Inquiry and
nothing to do with making the decision to render healthcare to an
individual. Your example above is specious.
Then apparently you quote William as saying::
"> It seems that the NM1 in the Other Payer Patient Information loop (2330C)
> has the NM103 (Individual last name or organizational name) marked as
> "Required," though that makes no sense considering the NM1 in this case
> is used to provide additional identifiers for an already known entity."
Again, you both have taken something out of what appears to be the 837 claim
submission and tried to drop it into the 270 Eligiblity Inquiry.
If either of you had bothered to look at the transaction set for
eligibility, which is/could be used in the decision making process
for rendering healthcare, you would have easily seen that no where is there
any requirement for "other payer patient information." To wit,
here's the structure of the 270:
Information Source (Loop 2000A)
Information Receiver (Loop 2000B)
Subscriber (Loop 2000C)
Eligibility or Benefit Inquiry
Subscriber (Loop 2000C)
Dependent (Loop 2000D)
Eligibility or Benefit Inquiry
Eligibility or Benefit Inquiry
Information Receiver (Loop 2000B)
Subscriber (Loop 2000C)
Eligibility or Benefit Inquiry
Information Source (Loop 2000A)
Information Receiver (Loop 2000B)
Subscriber (Loop 2000C)
Eligibility or Benefit Inquiry
Subscriber (Loop 2000C)
Dependent (Loop 2000D)
Eligibility or Benefit Inquiry
Now, this doesn't mean that I don't agree with you, Jonathan, that taken as
a whole the HIPAA X12 implementation
guides leave a lot to be desired, are not consistent and cohesive
throughout, and quite frankly create more questions
than are answered. This is what you get when you develop stuff by committee,
a camel! Each one of these guides
was developed by a separate work group and they don't hang together as a
whole as well as they should.
Personally, I think the issue of whether the HIPAA guides comply with the
X12 technical report is bogus. The real issue
should be a focus on the standardized DATA content and not on the syntax for
formatting the data. Formatting
date is a walk in the park compared to standardizing/normalizing data, and
this is where the real issues are in
health care.
Come on boys, both of you can play in the same sand box without throwing
sand at each other on this issue. Argue
about what really counts!
Rachel
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