Jan, I totally agree with your viewpoint. It is kind of ironic that we have standards to the level of data elements/data values but the usage of the whole transaction could be payer specific. In some cases, same service could be on 837I for one payer and on 837P for other payer.
Sujay Pidara Radicle Incorporated 773-991-6018 >>> Jan Root <[EMAIL PROTECTED]> 05/01/02 12:14PM >>> Providers might respectfully disagree with you. This practice actually does cause some providers quite a bit of angst, and, from a COB perspective, it causes payers problems as well. Currently, providers who have to bill using different forms are faced with the challenge of billing the identical services two (or more) different ways: for Payer A you bill service X on a UB-92 and for Payer B you bill service X on a HCFA-1500. It's not easy. Then, imagine a COB situation where the prime requires the service on a UB-92 and the secondary requires it on a HCFA-1500. This can make it difficult to impossible to submit electronic COB claims where payers are asking for different billing forms. Some providers are forced to maintain two (or more) separate billing systems to bill for identical services. This, at least on the outset, certainly seems like an unnecessary administrative cost to providers, something that contributes to higher health care costs that could be eliminated without impacting patient care. Payers typically don't experience it too much because they can require claims to be submitted in whatever format they want. The exception is in their COB departments - you end up with comparing apples to oranges, plus it probably unnecessarily increases your paper COB claim volume. So, I think one could argue that there is an 'administrative simplification' issue here. Jan Root "Narog, Jeffrey B230" wrote: > Yes, and more specifically, it's left up to payers and providers to > establish this in their trading partner agreements. There shouldn't be a > regulation that specifies which provider types should use which > transactions, as long as they are HIPAA transactions. There are some > provider types - such as hospitals, for example - that would use both the > 837P and 837I, depending upon which services are being billed. This has been > a common practice for many years, which has worked without any major > problems, and doesn't need to be regulated. > > -----Original Message----- > From: Askew, Lindsay W [SMTP:[EMAIL PROTECTED]] > Sent: Tuesday, April 30, 2002 2:20 PM > To: [EMAIL PROTECTED] > Subject: RE: Institutions? > > HIPAA doesn't specify who has to file which version of the 837, it's left up > to informal business rules. > > -----Original Message----- > From: Bob Warner [mailto:[EMAIL PROTECTED]] > Sent: Tuesday, April 30, 2002 12:18 PM > To: [EMAIL PROTECTED] > Subject: Institutions? > > > I am assuming that an institution (thus being required to file an > 837i transaction) includes places such as hospitals, residential treatment > facilities, nursing homes (hospice facilities?) and similar types of > facilities. Are there any facilities which also are required to file the > 837i but are not obviously institutions? > > Thanks, > > Bob > > Robert E. Warner > Department of Human Services > 3520 W. Oxford Ave > Denver, CO 80236 > Phone - (303)866-7301 > E-mail - [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> > > ------------------------------------------------------------------------------ > CONFIDENTIALITY NOTICE: If you have received this e-mail in error, please >immediately notify the sender by e-mail at the address shown. This e-mail >transmission may contain confidential information. This information is intended only >for the use of the individual(s) or entity to whom it is intended even if addressed >incorrectly. Please delete it from your files if you are not the intended recipient. > Thank you for your compliance. Copyright (c) 2002 CIGNA > > ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
