Here is a case where both of you are sort of
right.
Maria was trying to point out the fact that the Business
Function associated with distribution of a PENDED Claim Listing, usually
triggered by a time factor (e.g. weekly, twice a month etc.) from a payer's
adjudication system to a provider, which only contains claims in a "PENDED"
status from the payer's system.
The business scenario just described is
not the HIPAA named transaction standard.
The objective from the previous
emails to this thread eluded to the question can a payer respond to an inquiry
from a provider which contains information about a claim which is "PENDED" in
the payer's adjudication system and the answer is absolutely yes it
can.
The distinction is what is the triggering
event.
Did the provider initate the inquiry by sending a 276
transaction and the payer is responding by the HIPAA covered 277 as documented
in the 004010X093 implementation guide, when this scenario is yes your in
HIPAALAND.
When the payer enters into a trading partner agreement
to supply a list of claims which are pending in the adjudication system, then
your out of HIPAALAND. You actually have a couple of options on how to
accomplish this as well.
Michael J. Cabral
Co-Chair Claim Status Work
Group
EDS
800 Connecticut Blvd 3rd Floor
East Hartford, CT
06108
-----Original Message-----
From: Young, Brian [mailto:[EMAIL PROTECTED]]
Sent:
Friday, February 22, 2002 3:43 PM
To: '[EMAIL PROTECTED]'
Subject: RE:
Notifying Providers of Pended Claims
Maria,
If I understand
what you are indicating... If a provider
sends a 276 claim status request and
that claim is pended,
the 277 does not cover that pended status
response
possibility so no response can be sent. Nor can a
payer
send a 277 (unsolicited) back with a 835 containing any
pended
claims.
And the reason is because "Pended" claim status is not
a
HIPAA transaction. Am I understanding you correctly?
If so
this would seem like splitting hairs. For certainly
the 277 does cover
claim status reporting.
BCY
Brian C. Young
Senior
Software Engineer
Accu-Med Services
An OmniCare Company
300
TechneCenter Dr.
Milford, OH
45150
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