Hi,
I have a couple of questions related to the following scenario:
A payor is providing a web based product to their providers for the
submission of referral/authorization requests.
1. For the CR608 segment, does every certification type code have to be
offered online? I think some payors may not want to do appeals
electronically, especially when the PWK (Paperwork) segment has not been
implemented (as described in the 278 addenda document). Additionally, some
plans may not have "Extension" of ref/auth in their current business
processes, but may instead require new requests be submitted.
2. Can the screen display "Plan or Payor" terms for Service Type Codes
(UM03) ? This assumes that the mapping is appropriate and does not change
the intent of the UM03 code. For example "Consult" for UM03 3,
"Consultation" and "Specialist Visit" for UM03 99, "Professional
(Physician) Visit - Office."
3. If no field currently exists on the entry screen for Location (Health
Care Service Location) for those services where location is not implicit by
the identified provider, would a resolution of the following be compliant:
adding service types of (for example) hospice/home and hospice/inpatient on
the screen AND behind the scenes for the transaction map to UM03 42 plus
UM04 appropriate information per each service type just mentioned.
thanks,
Connie Lagneaux
