Scenario B would not be compliant with X12 Syntax.
Your scenario A assumes there are two different billing providers and in
each case the subscriber is NOT the patient. If there was one billing
provider and the subscriber was not the patient the HLs for Scenario A
would be:
Billing Provider/Subscriber/Patient/Subscriber/Patient.
If the first subscriber was also the patient the HLs would be as follows:
Billing Provider/Subscriber/Subscriber/Patient
See pages 37 - 40 of the professional implementation guide for examples of
how the HL structure can look. This example is also in the institutional
and dental guides.
Dianne Barbieri
Consultant - HIPAA National Practice
908-931-4806
t/l 391-4806
"Ken Hoover" <[EMAIL PROTECTED]> on 10/15/2001 04:00:35 PM
Please respond to <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
cc:
Subject: 837 Transaction Set Hierarchy
What guarantees that the transaction sets will be hierarchically compliant?
For example:
Scenario A
Billing Provider/Subscriber/Patient/Billing Provider/Subscriber/Patient ...
versus
Scenario B
Billing Provider/Billing Provider/Subscriber/Subscriber/Patient/Patient ...
Either case the HL sequence could link the child back to the appropriate
parent. Are both scenarios compliant?
Thanks for your help!
Ken Hoover
Acclamation Systems, Inc.
[EMAIL PROTECTED]
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