Re: Paper Claims Incoming / 837 Outgoing

[Martin Scholl]

Title: Paper Claims Incoming / 837 Outgoing

Kris, Just a few weeks ago I came across Datacap. www.datacap.com. They were always strong in the OCR business and now created a paper-to-X12 product. Maybe that is something you could use.   Also, as a less cumbersome product, I am working on an EDI frontend that reads UB92 print files, stores the data in its own database and creates X12 837s. The software can receive 835 and register remittances and is planned as a claim administrator.   Martin Scholl Scholl Consulting Group, Inc. 301-924-5537 Tel 301-570-0139 Fax [EMAIL PROTECTED] www.SchollConsulting.com     ----- Original Message ----- From: Owens, Kris To: [EMAIL PROTECTED] Sent: Friday, May 24, 2002 2:47 PM Subject: Paper Claims Incoming / 837 Outgoing We are an MCO (managed care organization).  We have three lines of business, commercial (both fully insured and self insured), Medicare +Choice, and Medicaid.  These are all Managed Cared programs. We currently are obligated by both CMS and our local Medicaid agency to report "encounter" data ("paid" claims data).  CMS came out this month and announced that they would no longer require "encounter" data, rather they will require "data to support risk adjustment".  Further more this "data to support risk adjustment" is very condensed, (six fields total) and would not be required to be sent in the 837 format (although they will accept the 837 if an MCO chooses to use it). Our Medicaid agency currently requires their version of the NSF and have not made a decision yet as to whether they will require the 837 or not. We are very concerned about how, if our Medicaid agency requires the 837 format, we will bridge the gap between paper claims and the 837.  If our Medicaid agency wants the 837, we will not have a choice to submit the incoming paper claims to them any differently than the incoming 837s.   Here's our question (at last), through our regional SNIP (NMCHILI) we have just started a workgroup to develop a state wide approach to this issue, but we are wondering how other MCOs in other states are dealing with this issue - especially states like Kansas and Michigan where their Medicaid agency is requiring the use of the 837? Kris Owens Senior IS Project Manager - HIPAA Project Presbyterian Healthcare Services Albuquerque, NM 505.923.8108 [EMAIL PROTECTED] "There is no meaning in isolation" --- PRESBYTERIAN HEALTHCARE SERVICES DISCLAIMER --- This message originates from Presbyterian Healthcare Services or one of its affiliated organizations. It contains information, which may be confidential or privileged, and is intended only for the individual or entity named above. It is prohibited for anyone else to disclose, copy, distribute or use the contents of this message. All personal messages express views solely of the sender, which are not to be attributed to Presbyterian Healthcare Services or any of its affiliated organizations, and may not be distributed without this disclaimer. If you received this message in error, please notify us immediately at [EMAIL PROTECTED]