Jim Yes, the 277 unsolicited would be another avenue particularly if you used it as your routine front-end acknowledgement transaction. Here at UHIN we're getting ready to fire up a 4020 version of it (the WG is now on the 4040 version; UHIN needed to implement now (you know how that goes) so we decided to do 4020 but 4040 is definitely an improvement over 4020). If you were to send a 277 front-end acknowledgement (277FE) for ALL your claims the providers would be routinely reading them. You could reject such claims on the front-end (if your system can do so) and that would save you from bringing them in and having to issue an 835 on the back end.
Just an idea. I know providers LOVE the 277FE. It's detailed, all the payers using it use the same codes (providers now face the problem that everyone uses different accept/reject codes - acknowedgements are really a nightmare to decipher!) - in our tests it seems to work quite well. I think NCVHS is considering recommending that the 277FE be included in the HIPAA-2 suite of transactions. Jan Root "J.G." wrote: > I think we may try to go ahead with Mike's or Jan's suggestion of using > either the 101 or 110 adjustment reason code initially. I'm concerned that > these will result in phone calls instead of conveying what we really want to > convey. The 101 suggestion seems to indicate that we expect to pay $0 when > we may actually pay something when the claim is filed. But this was also > what we came up with. The 110 may make it seem that we thought it was a > claim instead of a predetermination, but may actually get the point across > to some of the providers. > > Therefore we will probably go ahead and request a new code, and when/if it's > issued we will simply have to make a quick update to a table on our system. > > My concern about unsolicited claims status is that from experience there are > many providers who never look at it, and again there's the same issue that > they won't really be informed that we don't do predeterminations and will > call instead. However, it's a good point to consider since our system will > create entries on a database so that we can respond to a solicited claims > status, and we will need to decide what claims status codes are most > appropriate. > > Thanks for all the suggestions. It was helpful to see that people seemed to > go through similar thought processes when looking at this. > > Jim Griffin > Business Systems Analyst > CNA > > -----Original Message----- > From: Falbowski, Ellen [mailto:[EMAIL PROTECTED]] > Sent: Wednesday, January 16, 2002 11:48 AM > To: '[EMAIL PROTECTED]' > Subject: RE: Predetermination of Dental Benefits > > Couldn't this be also handled via the unsolicited 277 claim status? The > STC01 could carry E0 (Error in submitted request data) or A3 (Returned as > unprocessable) in the Category Code and 187 (Date(s) of service) in the > Status Code. > > -----Original Message----- > From: Jan Root [mailto:[EMAIL PROTECTED]] > Sent: Wednesday, January 16, 2002 2:17 PM > To: [EMAIL PROTECTED] > Subject: Re: Predetermination of Dental Benefits > > Jim > You are correct that there is not a good way to do this in the 835. You > might > try using code '110 - Billing date predates service date' in the claim level > CAS > but I can see that it would be quite a stretch.... > > I would suggest that you contact the Codes Maintenance Committee and request > a > new Adjustment Reason Codes. You might also want to request a new Claim > Status > Reason Codes if you think you might need this to respond to a claim status > inquiry (the same committee handles both code lists). This could be a > pre-adjudication rejection. Requests for new codes can be made at > http://www.wpc-edi.com/conferences/crc.html. Login and go to the February > 2002 > Issues and Agenda topic under Issues & Requests (you might have to hit the > 'more' > button at the bottom of the list). > > j > > "J.G." wrote: > > > 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. > > ********************************************************************** > 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.
