Martin, It appears that what you are proposing is more of a "pricing query" than an "eligibility query", an issue that we are also facing in vision care. Most vision plans are structured like retail pharmacy plans, in that a set of complex rules exist in virtually every case that would allow the provider (of eyeglasses, for example) to know ahead of time not only the patient's co-payment (an eligibility item), but the provider's payment and contract "write-off" adjustment (pricing items). I understand that the Dental 837 has a flag that permits its use as a "pricing query". Presumably, NCPDP supports this somehow for retail pharmacy.
I don't believe the 837-P can be used in this manner.. can it? If not, it should probably be considered. -Chris At 08:45 AM 5/21/02 -0400, Martin Scholl wrote: >One of the most important tasks of insurance validation is to find out how >much I get paid as a provider. >I am not sure how I can do this with the 270/271 transaction set. >For example: >A provider indicates in the EQ segment a Composite Medical Procedure >Modifier (HC:46735). He/She wants to charge $20,000 for this operation. >Where in the 270 would I indicate the proposed amount? > >Where in the 271 would I indicate how much a payer actually pays for this? >EB07? > >Martin Scholl >Scholl Consulting Group, Inc. >301-924-5537 Tel >301-570-0139 Fax ><mailto:[EMAIL PROTECTED]>[EMAIL PROTECTED] >www.SchollConsulting.com > Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
