Our company is wrapping up the gap analysis for the 837 transactions sets, and we have two fundamental questions:
1) It appears to us that the 837 format only needs to be used when claims information is sent to an entity for claims adjudication purposes. It does not need to be used for outbound files that relay claims information where party number 1 and party number 2 have a predefined format for the claims information. Is this true? 2) We are trying to determine how many of the new and situational fields we are going to retain in our system even though our system does not need these new fields for the adjudication of a claim. At this time, we will not be supporting electronic payer-to-payer COB transactions. If we were, we would need to retain all of the information. There are several Q&As on the HHS website related to this topic. One in particular, dated 8/27/01, says: "Health plans and health care clearinghouses are required to be able to accept the maximum data set; this includes maximum field lengths as well as all of the required and situational data elements possible in a standard transaction. Extraneous data does not have to be processed; however, if a health plan electronically performs coordination of benefits, with another health plan, the health plan must store the COB data that is necessary to forward to the other health plan." Based upon this Q&A, would it be safe to say we can pick and choose the new fields we want to retain? Thanks. Diane Stapleton Quovadx, Inc. 5051 Journal Center Blvd, NE - Suite 410 Albuquerque, NM 87109 1-505-248-3944 [EMAIL PROTECTED] The information contained in this message and any attachments is intended only for the use of the individual or entity to which it is addressed, and may contain information that is PRIVILEGED, CONFIDENTIAL and exempt from disclosure under applicable law. If you have received this message in error, you are prohibited from copying, distributing, or using the information. Please contact the sender immediately by return e-mail and delete the original message from your system.
