Tom, Hal We want to respond to the Line level status inquiries on the claim level only due to inability to unbundle the lines. Will we be compliant? Alex Chernyak Medical Mutual
>>> [EMAIL PROTECTED] 04/11/02 01:47PM >>> 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] -----Original Message----- From: Hal Scoggins [mailto:[EMAIL PROTECTED]] Sent: Thursday, April 11, 2002 12:12 PM To: [EMAIL PROTECTED] Subject: Next 276/277 question 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 ********************************************************************** 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. ================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. 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