There are additional issues with the 835.
HIPAA does not link the 835 with the 837. A provider can ask for the 835
without sending electronic claims.
Providers sometimes send claims through multiple routes. They can even
want to the 835 to return through a different route (like a bank). The
payer must be told when a provider wants an 835 and which route to use.
Sending information down the wrong route can be a privacy problem.
To keep it short - there is NO substitute for provider to payer
communications for the 835.
Bob
Dave Minch
<dave.minch@jm To: [EMAIL PROTECTED]
mdhs.com> cc: [EMAIL PROTECTED]
Subject: RE: Time-out for terminology
question(s)
01/24/2002
06:43 PM
William,
I would guess that, following the pattern that appears to be present for
claim submission which i just finished commenting on, routing of the 835 or
277 would not depend so much on the ISA sender as it would on the 1000A
submitter. The 1000B receiver would have to have my "first-hop" address to
put into the ISA to respond to me.
If that is true, does it imply that i actually need to have a TPA with
every
payer i send information to? (yuck..!!) or if I use a CH, is it their job
to
update the next hop's routing tables (same question that you just asked),
and so forth until the payer's routing tables are eventually updated with
my
submitter id & route information? How does it work today when the paths
are:
Claim: provider ---> prov's CH ---> payer's CH ---> payer
Remittance: payer ---> prov's CH ---> provider (note the omission
of the
payer's CH)
Dave Minch
T&CS Project Manager
John Muir / Mt. Diablo Health System
Walnut Creek, CA
(925) 941-2240
