Hal,
I
don't think that list serve signup is fully automated. If that's true,
then your request will be routed to the list serve manager or managers who
will add you to the list. Please be patient, since it is a manual
process.
In
the remittance advice, the Line Item Control Number must be returned if
received on the corresponding claim. The purpose of the Line Item
Control Number is to aid the provider in matching the response to the original
line item. For example, in Dental claims, the provider frequently
performs the same procedure on multiple areas of the mouth. Since the
remittance advice only references the original procedure code, it would be
difficult or impossible to match the response to the line item. Note
that I'm not even considering the complications resulting from bundling or
unbundling of line items here.
In
the case of a claim status response, the service level response also
references the procedure code. As in the remittance advice, the
procedure code may not be sufficient to match the response to the original
line item. It is the Line Item Control Number that is a convenience to
the provider. It can also be a convenience to the health plan when
requesting claim status for a specific line item.
Hope
this helps.
Tom Drinkard
EDIT, Inc.
678-795-1251
[EMAIL PROTECTED]
Folks,
In the 276, the
REF segment entitled "Service Line Item Identification" (page 91 in the
original "Final" IG) contains the Line Item Control Number.
Note #2
for that segment states, "Required when available
from the original claim. When the Information Receiver is the Provider, this
is required when the number was assigned by the provider on the original
claim."
So let's step
through a scenario. Suppose I receive a 276 containing a Service Line
inquiry with no Line Item Control Number. I search my claims and locate the
Service Line in question. Lo and behold, I have a Line Item Control
Number for the Service Line stored in my database! Which means that it had
to come in on an 837, and had a Line Item Control Number assigned by
the provider.
If the Receiver
Name information and the Service Provider Name information are the same,
then am
I bound by law to stop at that point and reject the Inquiry as
non-compliant? That simplifies things for me, but it only causes delays for
the party requesting the claim status, and all over a minor technicality.
(Sort of sums up a lot of these compliance issues, doesn't
it?)
I think I
understand the reason for requiring the Line Item Control Number to be sent
if one exists; it makes it much easier to match to the claim in the Payer's
database. But once I've managed to locate the claim without it, it seems
silly to refuse to send back the information just because I now find that
they didn't send me some additional information that would have made my
search easier.
I'd be
interested in anyone's thoughts on the matter.
BTW, I
registered with the 276/277 listserv (X12N, TG2, WG5), but have not yet been
"accepted." It seems that one must justify their need to participate in an
X12 listserv.
Hal
Scoggins
SBPA Systems,
Inc.
(281) 679-7272
x116
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