We have been concentrating on other transactions and have not yet spent a great deal of time on the 276/277 yet, so I am not as familiar with the IG as for other claims - HOWEVER, as a healthplan you can bet we pend claims - we do it all the time - and I'd be surprised if other healthplans didn't as well? Maybe I don't understand your definition of "Pend"? When we say Pend we mean hold payment of claim to resolve an issue - I don't anticipate that will go away with HIPAA.
Kris Owens
Senior Project Manager - HIPAA Project
Presbyterian Healthcare Services
505/923-8108
[EMAIL PROTECTED]
HIPAA means a higher level of healthcare.
-----Original Message-----
From: Tucci-Kaufhold, Ruth A. [mailto:[EMAIL PROTECTED]]
Sent: Friday, February 22, 2002 11:27 AM
To: [EMAIL PROTECTED]
Cc: Reed, Denny; Jeff C. Howard (E-mail); Boni, Ken R; Daniel, Cindy C
non Unisys; Jeffries, Carol A.; Kirkwood, Frankie; Patty, Kermit;
Simpson, Carol M non Unisys; Stull, Judy L.; Armistead, Steven B.;
Barron, Joyce; Batten, Anita; Bowen, Lynda; Collins, Tim; Daou, Wael H.;
Deters, Wayne E.; Donock, Stanley R.; Faris, Jimmie; French, Kirk;
Holbert, Carilon; Horne-Jones, Jeanne R.; Hutchens, Steve R.; Kreisher,
Debra A.; McKenzie, John E.; Phillips, James D.; Rangel, Beth Ann;
Reynolds, Judy; Robbins, Carol J.; Vacha, William R.; Lu, Alice;
Stuart-Vail, Mary; Kurtzman, Mark
Subject: RE: Notifying Providers of Pended Claims
During the X12N conference, there was an Claims Status informational forum
held by this X12N-TG2-WG5 to discuss the "actual" work being done in this
workgroup. There was a misunderstanding in the industry as to the
development of an unsolicited 277 claims status implementation guide.
This workgroup decided that since only one portion of the industry
(Medicaid) would be using this, that the development would be shelved until
a better business case was presented. At that point, myself and Kathleen
Conner from Fox systems engaged the co-chairs in discussions that ultimately
led to the agreement that Ruth and Kathleen would draft a white paper that
described the desired use of the 2nd half of the 276/277 X093 transaction
for reporting pended claims and get it approved by NMEH and then NMEH would
send it to X12N-TG2-WG5 for review and "approval". That way a new guide
would not have to be developed (more time wasted) and the industry has a
mandated solution. By the end of the conference the white paper was in its
preliminary draft state to be emailed to Kathleen Conner for review. This
white paper has been emailed to Kathleen and Kim Meyer for review and then
subsequently to NMEH.
If you feel that Medicaid is NOT the only part of the industry that pends
claims, then maybe WG5's finding are not accurate. But the solution should
still stand and just some of the front matter of the current guide change so
that the 837 could also function as the "request" portion for a 277 to
respond to.
Thoughts?
Ruth Tucci-Kaufhold
UNISYS Corporation
4050 Innslake Drive
Suite 202
Glen Allen, VA 23060
(804) 346-1138
(804) 935-1647 (fax)
N246-1138
[EMAIL PROTECTED]
-----Original Message-----
From: Jan Root [mailto:[EMAIL PROTECTED]]
Sent: Friday, February 22, 2002 11:55 AM
To: [EMAIL PROTECTED]
Subject: Re: Notifying Providers of Pended Claims
Dan
There is an 835 adjustment code for pended claims:
133 - The disposition of this claim/service is pending further review.
Also, as a thought,
Payers here in Utah who have this problem are considering using the 277U for
this
business need. It's not a HIPAA transaction but it would work fine. Plus,
they
figure since they have to implement a 277 anyway, it's not that much more
work to
implement another type of 277. And, the providers' software can handle it
with
little extra work (since they will be handling a 277 anyway).
Jan Root
"Clark, Dan" wrote:
> We currently notify Providers of their pended claims on our proprietary
> electronic remit. There is no allowance for that in the new 835. We are
> trying to decide whether or not continue this practice and if so, how? We
> are considering generating paper "letters" that would be mailed to
> providers. We are also looking at creating a separate proprietary
> electronic pend notification transaction. And as previously stated, we
> are also considering stopping the process of sending this information to
> Providers.
>
> I would appreciate hearing from anyone who has a similar dilemma and let
me
> know how you are handling it.
>
> Thanks very much
>
> Dan Clark
> 804-678-0053
> [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
>
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