I have a question regarding the 837 Institutional Explanation of Benefits
Indicator (page 163 of the IG).  This is a Yes/No Condition or Response
code.  To quote the IG, "A 'Y' value indicates that a paper EOB is
requested; an 'N' value indicates that no paper EOB is requested."

My question - is this intended to override any pre-existing agreement
between the payer and the provider?  If a payer has an agreement to send an
835 to the provider and the provider then submits an 837I with a 'Y' does
the payer just send a paper EOB or do they send paper in addition to an 835?

I'm really interested in hearing what the provider community would be
expecting if they sent an 837I with a 'Y' EOB Indicator.  This is a required
data element on the 837 Institutional only, it does not exist on the 837
Professional or 837 Dental.

Thanks,

Andrea R. Hain  




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