Jonathan,
It is literally impossible to send a HIPAA compliant 835 from a paper
transaction. Their are omitted fields, codeset problems, truncation, etc.
If you read the ASPIRE white paper their are other issues. Their are many
fields that are not discernable on HCFA 1500 to convert to proper 835
fields.
Other issues we have found:
� The following fields are what have been identified as coming from the
ANSI 837 transaction. If they are filled in by the claims systems, there is
a chance the information would not match the claim submitted, therefore
causing problems in provider billing systems. Situations that would cause
this are truncation of names and claims examiner flexibility in entering a
paper claim (Codes may change based on policy language; the original codes
are not maintained except on the paper). In addition, the marked (a)
fields were identified in the ANSI 835 Implementation Guide as coming from
the ANSI 837 transaction. There is a compliance issue of not following the
IG specifications.
TS3 Provider Summary Information CLP Claim Payment Information
TS301 Provider Identifier a CLP01 ?
Patient Control Number
TS302 Facility Type Code CLP03 ?
Total Claim Charge Amount
a CLP06 ? Claim Filing
Indicator Code
a CLP08 ? Facility Type Code
a CLP09 ? Claim Frequency Code
NM1 Patient Name
NM103 ? Patient Last Name
NM104 ? Patient First Name
NM105 ? Patient Middle Name
NM108 ? Identification Code Qualifier
NM109 ? Patient Identifier
NM1 Insured Name NM1 Service Provider Name
NM102 ? Entity Type Qualifier NM102 ? Entity Type
Qualifier
NM103 ? Subscriber Last Name NM103 ? Rendering
Provider Last Name or
NM104 ? Subscriber First Name Organization
Name
NM105 ? Subscriber Middle Name NM104 ? Rendering
Provider First Name
NM107 ? Subscriber Name Suffix NM105 ? Rendering
Provider Middle Name
NM108 ? Identification Code Qualifier NM107 ?
Rendering Provider Name Suffix
NM109 ? Subscriber Identifier NM108 ?
Identification Code Qualifier
NM109 ? Rendering Provider
Identifier
REF Other Claim Related Identification REF Rendering Provider
Identification
REF01 ? Reference Identification Qualifier REF01 ?
Reference Identification Qualifier
REF02 ? Rendering Provider Secondary
Identifier
SVC Service Payment Information REF Service Identification
SVC01-1 ? Product or Service ID Qualifier REF02 ?
Provider Identifier
SVC01-2 ? Procedure Code
SVC01-3 ? Procedure Modifier
SVC01-4 ? Procedure Modifier
SVC01-5 ? Procedure Modifier
SVC02 ?Line Item Charge Amount
SVC04 ? National Uniform Billing
Committee Revenue Code
SVC07 ? Original Units of Service Count
REF Rendering Provider Information
REF01 ? Reference Identification Qualifier
REF02 ? Rendering Provider Identifier
Thank you,
Terry Christensen
[ IS Administration Simplification EDI
Telelphone: (402)351-6370
Fax: (402)351-8025
e-mail: [EMAIL PROTECTED]
JONATHAN.SHOWALTER@
bcbsne.com To: [EMAIL PROTECTED]
cc:
10/25/2001 11:07 AM Subject: RE:Issue from a recent
conference
Please respond to
transactions
The 837 and 835 are independent transactions. A provider may send all,
some
or none of their claims via the 837. Also, they may choose that all of
their
remits be sent back via the 835. What is important to understand is that a
provider could be sending paper claims and receive back an 835.. that is
perfectly within their rights under HIPAA. Currently, the only way to know
whether or not to send/receive any transaction is for the two trading
partners
to talk. Personally, I hope we can find a more automatic way to do this
but
in the short term this is what you will need to do
I hope that helps
Jonathan Showalter
Omaha NE USA
402-343-3381
[EMAIL PROTECTED]
------------------( Forwarded letter 1 follows )---------------------
Date: Thu, 25 Oct 2001 08:29:52 -0500
To: transactions.wedi.org[transactions]@wedi.org
From: Tarry.Hauser[THauser]@mahealthcare.com
Sender: [EMAIL PROTECTED]
Reply-To: [EMAIL PROTECTED]
Subject: Issue from a recent conference
"There did not seem to be a definite answer on how we know that we should
send an 835 transaction back when we receive an 837. At one point there was
to be a routing # if the Provider wanted the 835 back. However, there is
nothing in the data field such as a routing # to know."
This question cam back to me after one of our own attended an SPBA
conference. Do we have an answer for this anywhere in the regs?
Tarry L. Hauser
Applications Specialist
Medical Associates Health Plans
700 Locust Street Ste 230
PO Box 5002
Dubuque, IA 52004-5002
(319)584-4830
FAX (319)556-5134
**********************************************************************
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.
(See attached file: UnNamed.html)
Q"There did not seem to be a definite answer on how we know that we should send an 835 transaction back when we receive an 837. At one point there was to be a routing # if the Provider wanted the 835 back. However, there is nothing in the data field such as a routing # to know."
This question cam back to me after one of our own attended an SPBA conference. Do we have an answer for this anywhere in the regs?
Tarry L.
Hauser
Applications Specialist
Medical Associates Health Plans
700 Locust Street Ste 230
PO Box 5002
Dubuque, IA 52004-5002
(319)584-4830
FAX
(319)556-5134
**********************************************************************
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. N�ޭ騽�_����+%��lzwZ��,j���ڞƜ�*'�W��� v*+��^jǧ���b�f��� ��h�hh��-���q�,ʋ���z�
