Hal,
I
agree with you that to reject the 276 as non-compliant in your scenario would be
both silly and counter-productive.
I'm
not sure that you have to judge compliancy based on your data files. I
think that compliance would apply to the incoming 276 on its face.
Certainly any of the transaction certifiers would judge the transaction to be
compliant, since they don't have the knowledge and data available that you
have.
The
above is my opinion only, with no quotes or cites to help.
It
just makes sense to me.
Tom Drinkard
EDIT, Inc.
678-795-1251
[EMAIL PROTECTED]
Tom,
Thanks for your response.
Your
explanation does expand on why the Line Item Control Number can be helpful to
the Information Receiver as well as the Information Source. But my main
question was, if I am able to locate the Service Line without it, should I
refuse to return the status simply because it has now been revealed that the
Inquiry is non-compliant?
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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