I forgot to include that the easiest method would be add logic to in your translator to create the error message when the CLM19 is equal to PB.
Hope > -----Original Message----- > From: Hope Furtado > Sent: Wednesday, January 16, 2002 9:03 AM > To: '[EMAIL PROTECTED]'; '[EMAIL PROTECTED]' > Cc: Hope Furtado > Subject: RE: Predetermination of Dental Benefits > > Jim, > > I recommend the use of the 997 Segment with an error message on the at > the Subscriber level indicating that you do not do predetermination of > benefits. I copied the following from the 837 Dental Implementation Guide > > Functional Acknowledgment, 997 > The Functional Acknowledgment Transaction Set, 997, has been designed to > allow > trading partners to establish a comprehensive control function as a part > of > their business exchange process. This acknowledgment process facilitates > control > of EDI. There is a one-to-one correspondence between a 997 and a > functional > group. Segments within the 997 can identify the acceptance or rejection of > the functional group, transaction sets or segments. > > Please contact me if you want to discuss this further. > > Hope Furtado > Corporate Information Architect > TM Floyd & Company > (800)780-1170 ext 129 > [EMAIL PROTECTED] > > > -----Original Message----- > From: J.G. [SMTP:[EMAIL PROTECTED]] > Sent: Tuesday, January 15, 2002 8:38 PM > To: [EMAIL PROTECTED] > Subject: Predetermination of Dental Benefits > > > Our plan includes both medical as well as limited dental coverage. > We do > not do any predetermination of benefits today. If a provider calls > in we > tell them we don't predetermine benefits. If they send in a paper > form we > respond with a form letter telling them we don't predetermine > benefits. If > they ask specific questions on the phone, they may get some > additional > information, but nothing that should be close to an actual > predetermination. > > The 837 Dental Claim transaction allows for a predetermination > request. The > 835 Remittance Advice allows for a response. However, I don't see a > way to > indicate that we don't perform predeterminations. Is there a way to > do this > in the 835, or is there another way to respond to this? > > Jim Griffin > Business Systems Analyst > CNA > > > > > > ********************************************************************** > 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.
