--------------------------------------------------------
C.J.
Major
Consultant - Comsys, Inc.
Arizona Department of Health
Services
Division of Behavioral Health Services
[EMAIL PROTECTED] T.
602.553.9082
F.
602.954-7259
--------------------------------------------------------
>>>
[EMAIL PROTECTED] 2/25/02 9:21:42 AM >>>
Kepa
The
issue is that the U277 is NOT available on WPC as it was previously.
The IG
number of X093 was changed to the front-end ack.
Basically all we are
asking WG5 (via NMEH in the white paper being
developed) is that since WG5
made this decision, what is the 'problem' with
trading partners agreeing to
use the 277 STANDARD and agree to its
implementation OR for those wanting
to use a 'mandated' txn just use the
x093 277 with the 837 as the 'request'
portion and change the front matter
(as quoted by Maria earlier) to
"describe" the usage: Claim Status whether
requested from a 837 or
276 should yield the same result.
Seems simple to me ... sorry to
create a "ruckus".
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: Kepa Zubeldia [
mailto:[EMAIL PROTECTED]]Sent:
Saturday, February 23, 2002 1:53 PM
To: [EMAIL PROTECTED]
Subject:
Re: Notifying Providers of Pended Claims
Maybe I am denser than
usual today...
Is there anything that prevents a payer or a provider
from implementing
the "unsolicited 277" transaction today? I know
the implementation
guide is not very "fresh", but it is available in the
wpc-edi web site.
Or, are payers waiting to be mandated by the
government to implement
this transaction?
Ditto for the 271 roster,
or for the upcoming 824.
Kepa
Christopher J. Feahr, OD
wrote:
> The inability of a payor to use the 277 to send an
un-solicited LIST of
> pended claims does seem like a technicality that
could be fixed... if
> there was a really need to do that. The
more likely scenario, however,
> is that a provider wants to ask "what
the heck's going on with" a list
> of UNPAID claims. If the 276
doesn't allow him to ask for status on a
> "list" then he could
alternatively send a whole bunch of separate 276s.
>
> Medicaid
does seem to be the only payor who periodically sends me
> unsolicited
lists of "pended" claims... and as a provider I find this
> generally
unhelpful, and in some cases highly annoying. The process of
>
filing a Medicaid claim is frequently automated and can be done
>
electronically. "Resubmission Turnaround Documents" and "Claim Inquiry
> Forms", however, are generally not automated and would have to be
filled
> out manually (paper) and mailed. Consequently, many
providers who get
> an "RTD" in the mail or see a denial (due to an
accidental submission
> error) on an EOB, find it more expedient to
simply resubmit the claim
> with the corrected information. Long
after the second (resubmitted)
> claim is settled, the provider
continues to get these unsolicited
> notifications that the original
claim is still going through this slow
> death process involving
various stages of "suspension". The provider
> soon learns to
ignore all/most unsolicited status status advice like this.
>
> I
would say that if the provider isn't yelling at a payor about a pended
> claim, it means that he DOESN'T WANT any status information about it.
> (or it means that he's asleep, in which case he doesn't deserve any
> status information and would probably be confused by it if the payor
> sent it out of the blue!)
>
> Regards,
>
Chris
>
> At 04:42 PM 2/22/02 -0500, Young, Brian wrote:
>
>> 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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>>
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>
>
> Christopher J. Feahr,
OD
>
http://visiondatastandard.org>
[EMAIL PROTECTED]
> Cell/Pager:
707-529-2268
>
>
>
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