Good morning Sean, September is one of my favorite months.
You have stumbled down the same path I have been on for the last couple of months. As I have worked with several major payer organizations I have discovered an entire realm of copays that I never envisioned ranging from "Electroshock Therapy" to "IV Therapy" that simply do not map to any EB03 service type codes. To quote Rachel Foerster "Where the heartburn is: the Semantic Alignment of Business Data", the process of mapping revolves around the actual meaning of data. Data is stored somewhere that has specific business meanings, that information is sent using EDI X12 standards and code sets, elsewhere that data is read and hopefully the same business meaning is derived by the receiver. Back to your specific problem. The first one is easy: EB*B*92**27*5**VS*1~ The next two cannot be defined, what is the business meaning behind "Preferred" and "Non-preferred"? If there is no EB03 service type code for those two business types, then you have two choices. First, let X12 know that they may have missed a few copay codes and hopefully have them added to the code sets to be used "eventually". Second, change your system to accommodate the strict set of codes available in X12. Sometimes you can't get there from here! Bob Huffman RealMed Corporation Indianapolis, Indiana -----Original Message----- From: September, Sean A B230 [mailto:[EMAIL PROTECTED]] Sent: Wednesday, June 12, 2002 6:22 AM To: '[EMAIL PROTECTED]' Subject: Tiered Pharmacy Hello, I am currently working on the 270/271 HIPAA transaction set. I am attempting to display/map tiered pharmacy copayments/coinsurance amounts. For example: * Generic $5.00 * Preferred $10.00 * Non-preferred $15.00 The Service Type Codes (EB03) available are: * 88 = Pharmacy * 91 = Brand Name Prescription Drug * 92 = Generic Prescription Drug and for Mail order: * 90 = Mail Order Prescription Drug. I am finding it difficult to accommodate for the tiered pharmacy copayments/coinsurance. Is anyone else experiencing this dilemma and is there a solution? Your suggestions and assistance is appreciated. Sean A. September 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 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
