Todd: Your hypothetical scenario assumes the payer has an arrangement whereby all 835s (remittances) are submitted through CHB. Therefore, I suppose, the payer should return the 835 through CHB. The route whence the 837-I arrived is irrelevant, and all knowledge of the original claim's path is long gone. The 837 ceases to exist by the time it gets to adjudication: it has decayed into any number of atomic claims; see "Requirements Gathering - Information Flows," (16 Feb 2002) at http://www.mail-archive.com/[email protected]/msg00219.html.
As far as the provider is concerned, it doesn't matter what intermediaries are used to return application responses. In this case, CHB would likely recognize the ISA receiver ID for the provider (since the 837-I originally came in through CHB from the provider) and know where to deliver the 835. Even if CHB didn't recognize the receiver ID (say, the provider was using CHB as an "open portal" to reach the payer), the clearinghouse could use the Healthcare CPP Registry to look up the ISA receiver ID and figure out the EDI address of the provider. TA1 and 997 acknowledgements would probably be treated similarly (i.e., there's no X12 requirement that these traverse the same path as the interchange they're acknowledging). William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Velnosky Todd L" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, 30 May, 2002 05:17 PM Subject: 837/835 routing through clearinghouses I have a question that is articulated in the below hypothetical: Hypothetically, a payer has relationships with two clearinghouses to receive claims and submit remits: CHA and CHB. A provider sends an 837-I through CHB which, in turn submits to CHA to reach the payer. This process takes place due to the connectivity environment between the payer and CHB which only allows 837-P to be transmitted. The payer produces an 835 based on that 837. Could the payer submit the 835 to CHB or should it follow the same route through which came the 837 (via CHA)? Questions or comments contained herein are not the opinion or position of John Deere Health Care, Inc. or John Deere Health Plan, Inc.
