Julie, To take Erin's thought a step further...The system I help to support is based on many Payers' practices.
Benefit coverage, claim adjudication rules and claims pricing are each based on definitions set up before the claim comes in. A Provider Relations / Administration type department maintains info on provider credentaling / certification and the definitions of deals / contracts that are in effect. If a provider is certified in several Taxonomies, then that info would be on file and multiple contracts would probably be in place. Contracts (as well as other databases like Benefits) are defined by a myriad of fields including ... PayTo, Place of Service, Diagnosis, procedure code (or Revenue Code or Bill Type) ... and yes they can be categorized currently, into Provider Specialty. Our Claims processing 'assumes' the information already on file rules ... We'll accept data received on the claim, but we won't necessarily use it. With enhancements for HIPAA we will keep more of the input data like Taxonomy, on an ancillary file but we use the more clinical data indicated above to find the right contract. Marsha Verizon Information Technologies, Inc. Managed Care Division Phoenix, AZ Phone - 602.678.6042 Fax - 602.678.6331 E-mail - [EMAIL PROTECTED] Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. ---------- Original Text ---------- From: "Erin Harris" <[EMAIL PROTECTED]>, on 10/2/01 8:01 AM: To: smtp[<[EMAIL PROTECTED]>],smtp[<[EMAIL PROTECTED]>],smtp[<scw@podsmg .com>],smtp["Julie Thompson" <[EMAIL PROTECTED]>] Cc: smtp["Erin Harris DNET" <[EMAIL PROTECTED]>],smtp[<[EMAIL PROTECTED]>],smtp[<[EMAIL PROTECTED] >],smtp[<[EMAIL PROTECTED]>] Hi, Julie, A plan must receive standard data in the 837, but need not accept that data into their system, right? If the business rules dictate, and the contract with the provider specifies that the provider's claims will be processed with a consistent taxonomy code, would that not overrule any taxonomy value that might be sent in a particular claim? Erin Harris Deltanet, Inc. ----- Original Message ----- From: "Julie Thompson" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]> Cc: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]> Sent: Tuesday, October 02, 2001 7:50 AM Subject: Re: Identifying Provider Taxonomy Codes on 837 > Many providers are certified in more than one specialty, requiring the > taxonomy code to be claim specific. > > Such as an oncoloist, who is also, a hematologist. > Or, an orthopedic surgeon, who is also, a podiatrist. > > This vendor needs to comply with the HIPAA requirement to process the > taxonomy as sent on the 837. > > > > Julie A. Thompson > > > From: "Chuck Wunderlich" <[EMAIL PROTECTED]> > Reply-To: <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]> > CC: "Melissa Schoen" <[EMAIL PROTECTED]>, "Rhonda Carson" > <[EMAIL PROTECTED]>, "Dave Rein" <[EMAIL PROTECTED]> > Subject: Identifying Provider Taxonomy Codes on 837 > Date: Mon, 1 Oct 2001 13:46:33 -0700 > > We use a standard software package used by many other payers for processing > claims. Our vendor has chosen to only include the provider taxonomy code as > a "static" field in the provider contract table, rather than accepting the > code as billed by the provider on an 837. Therefore, we can only assign a > taxonomy code to a claim in our database by a relational link rather than > having the taxonomy code stored on the claim itself. I would like to hear > what others think about the acceptability of this approach as opposed to > requiring that the our database accept whatever taxonomy code a provider > chooses to submit on the 837. > > > ********************************************************************** > To be removed from this list, send a message to: [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. > > > > _________________________________________________________________ > Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp > > > ********************************************************************** > To be removed from this list, send a message to: [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. > > ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
