I work for a PPO that reprices claims for our customers. We are testing the 837 (inbound and outbound) with one of those customers now. They are using a clearinghouse to handle their inbound and outbound 837 transactions.
At issue is their test files are occasionally coming through with missing data that is required per HIPAA. At technical meetings concerning their files the clearinghouse is asking what to send in the data element, when the data is missing on the claim. The Data elements in question are: Institutional and Professional 837: In Loop 2300, CLM segment, position 8, "assignment of benefits" In Loop 2300, CLM segment, position 9, "release of information" Professional 837: In Loop 2300, CLM segment, position 5, "service location" In Loop 2400, SV1 segment, position 9, "emergency indicator" I'm sure as testing progresses there may be more of these situations. But for the above situations, am I correct in advising them that they can't use a default value in the absence of data? That if they want to transmit the claim via HIPAA compliant EDI, they'll have to return the claim to the provider in order to get the required information? Thanks for your input, Patricia Carney Customer Technical Analyst III Private Healthcare Systems 1100 Winter St. Waltham, MA 02451 Voice: (781) 895-6927 Fax: (781) 895-3416 Patricia Carney Customer Technical Analyst III Private Healthcare Systems 1100 Winter St. Waltham, MA 02451 Voice: (781) 895-6927 Fax: (781) 895-3416
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