> I'M DOING MAPPING USING THE PRO_EDI TRANSLATOR TOOL. I WANTED TO
> ACTIVATE PAT LOOPS FOR SOME OF THE CLAIMS, BUT THE APPLICATION FILE
> CONTAINS BOTH THE CLAIM DETAILS LIKE..
>
> 1. CLAIM DETAILS WHEN THE PATIENT IS SAME AS SUBSCIRBER.
> 2.CLAIM DETAILS WHEN THE PATIENT IS DIFFERENT(LIKE SPOUSE OR CHILD)
> FROM THE SUBSCRIBER. BUT IF I ACTIVATE THE PAT LOOP, IT ALSO APPLIES TO
> THE CLAIM DETAILS THOUGH THE PATIENT IS NOT DIFFERENT FROM THE
> SUBSCRIBER. COULD YOU PLEASE LET ME KNOW HOW TO DO THis? I WANT THE PAT
> LOOP TO BE ACTIVATED ONLY WHEN THE CLAIM DETAILS ARE DIFFERENT FROM
> PATIENT.
I don't know your product (although I do know where the shift-lock key is
located so I *can* type in mixed case), but you should only be getting claim
details at the subscriber level (2000B) when the patient is the subscriber ,
and only at the dependent (2000C) level when the patient is NOT the
subscriber.
For that matter, you should not be looking at the 2000-level for any "claim
information" at all because claim info is conveyed at the 2300 level. (CLM
opening segment).
I have no clue why your application file would contain a record layout with
space for claim details at both levels .. each claim "record" should include
the patient, and "if necessary" (subscriber<> patient) a place for the
subscriber info.
Michael C. Mattias
Tal Systems Inc.
Racine WI
[EMAIL PROTECTED]
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