So then we must determine if the remittance advice gets to be put on paper or an 835 by determining if the payment was based on an 837 claim or otherwise?
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Thursday, October 25, 2001 10:39 AM To: [EMAIL PROTECTED] Subject: RE:Issue from a recent conference 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. 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