Why not use A CAS segment with a Claim adjustment group code of "OA" and adjustment reason code of "133" and the charge amount
CAS*OA*133*100 Mike Winston Business Systems Analyst Trigon ISD Ph (804) 354-4521 Fx (804) 678-0452 [EMAIL PROTECTED] This message, including files attached to it, may contain confidential information that is intended only for the use of the ADDRESSEE(S) named above. If you are not the intended recipient, you are hereby notified that any dissemination or copying of the information is strictly prohibited. If you have received this message in error, please notify the sender immediately and delete the message from your system. Thank you. > -----Original Message----- > From: Tucci-Kaufhold, Ruth A. [SMTP:[EMAIL PROTECTED]] > Sent: Monday, February 25, 2002 3:02 PM > To: [EMAIL PROTECTED] > Subject: RE: Notifying Providers of Pended Claims > > > > It was my understanding after WG5 Info forum that the development of any > type of U277 guide was either "on hold" or the guide was not going to make > it to final. > > Is what you are saying is that the u277 x070 is not in draft today ... it > is a final IG that could possibly be used for reporting pended claims or > would that guide have to be 'reworked' to handle the pended status the way > the 277 portion of the HIPAA 276/277 guide works today? > > My knowledge outside the HIPAA guides are minimal at best. > > 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: C.J. Major [mailto:[EMAIL PROTECTED]] > Sent: Monday, February 25, 2002 12:45 PM > To: [EMAIL PROTECTED] > Subject: RE: Notifying Providers of Pended Claims > > > > > > OK, now I'm confused. I thought Kepa was talking about the > 3070X070 > 277:Health Care Payer Unsolicited Claim Status. That IG is still on > WPC > under Health Care Implementation Guides, not the HIPAA guides. > > Am I on the wrong page here? > > CJ > -------------------------------------------------------- > C.J. Major > Consultant - Comsys, Inc. > Arizona Department of Health Services > Division of Behavioral Health Services > [EMAIL PROTECTED] <mailto:[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 > >> > >> > >> > ********************************************************************** > >> 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. > > > > > > Christopher J. Feahr, OD > > <http://visiondatastandard.org> > > [EMAIL PROTECTED] > > Cell/Pager: 707-529-2268 > > > > > > > ********************************************************************** > > 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. ********************************************************************** 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.
