The 837 Transaction has the LOOP 2010BA, for Segment NM1 and the following fields NM108 and NM109 that are used by a provider to send the Subscriber Primary Identifier. NM108 is required when the insured is a person and NM109 is a required pair to NM108. You will have to match information such as sex, DOB, and Full Name. The best method would be to store the Subscriber Primary Identifier from the 837 Claim transaction and use this to cross reference to your internal subscriber identification number. As always, twins can present unique issues.
Please feel free to contact me if you would like to discuss this further or have any questions. Hope Furtado Corporate Information Architect TM Floyd & Company (800)780-1170 extension 129 [EMAIL PROTECTED] > -----Original Message----- > From: Thuppanna, Raj [SMTP:[EMAIL PROTECTED]] > Sent: Wednesday, February 13, 2002 6:52 PM > To: [EMAIL PROTECTED] > Subject: RE: 276 / 277 Claim Status > > Teresa, > I have a similar problem when I receive claims. I am thinking of > using the last name and date of birth as a last resort to identify the > insured/dependent. > As a payer I wonder why would you get a claim status? If you meant Claim > status request, there are few claim status codes that you can use in your > response to convey that you do not have enough/correct information to > adjudicate the claim. > > Raj Thuppanna > 770 444 4468 > > -----Original Message----- > From: Howeth, Teresa [mailto:[EMAIL PROTECTED]] > Sent: Wednesday, February 13, 2002 5:34 PM > To: '[EMAIL PROTECTED]' > Subject: 276 / 277 Claim Status > > As the Payor, we had not been doing EDI at all and went from no EDI to > HIPAA > compliant EDI. If a claim status is received and the Insured ID provided > is > invalid, do we have to provide the capability to search on names prior to > responding? The reason I ask is because we have a unique number assigned > to > each Insured and we are not always provided with the correct Insured ID. > Are we going to be required to accept in the transaction and search on > name > to locate the number prior to returning as not our Insured? > > I appreciate anyone who can assist. > > Thanks, > Teresa Howeth, Business Analyst > DP Admin > [EMAIL PROTECTED] > UICI http://www.uiciinsctr.com > 817-255-3338 Office > > > > ********************************************************************** > 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.
