Martin, We are working on the 276/277 as well and had originally thought that there would be a problem with too many claims fitting the search criteria. However, after closer examination of section 2.2.3.3.4 (pg 31) and the gray shaded note at the bottom of pg 86, when combined with the other search criteria, how many claims can you possibly have for a single provider, for a single patient, for a specific date(s) of service? Maybe several, but Alan's right, you can assure <99.
Jonathan Fox eCommerce Analyst Independent Health CONFIDENTIALITY NOTICE. This e-mail and attachments, if any, may contain confidential information which is privileged and protected from disclosure by Federal and State confidentiality laws, rules or regulations. This e-mail and attachments, if any, are intended for the designated addressee only . If you are not the designated addressee, you are hereby notified that any disclosure, copying, or distribution of this e-mail and its attachments, if any, may be unlawful and may subject you to legal consequences. If you have received this e-mail and attachments in error, please contact Independent Health immediately at (716) 631-3001 and delete the e-mail and its attachments from your computer. Thank you for your attention. >>> [EMAIL PROTECTED] 06/26/02 01:14PM >>> Thanks Alan, Now I get it too. I just started my work on the 276/277 complex and the more I get into it the more problems I see with this TCS. I agree with you that in order to uniquely define a claim, we should have the provider's claim # (CLM01) as a required field. REF*1K could be interpreted as this. The Member ID is a mandatory field for the subscriber level. This will narrow down a search. A bold solution to a query that returns more then 99 possible matches would be to use a Claim Status Category "A4 Acknowledgement/Not Found" and a claim Status of "0 cannot provide further information electronically". 99 + responses also sends a lot of PMI over the ether whereby 99% of it is useless. Think of the poor provider who has to wade through all this information. Martin Scholl Scholl Consulting Group, Inc. 301-924-5537 Tel 301-570-0139 Fax [EMAIL PROTECTED] www.SchollConsulting.com ----- Original Message ----- From: "Hirth, Alan" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, June 26, 2002 10:42 AM Subject: RE: Real Time overflow > > Actually, I do get your question. We have a whole log dedicated to it. We > are allowing search options which in a case of "claims from a provider for a > certain date" can result in many hits for a provider. I look forward to any > solutions out there. Aside from the REF-BLT for institutional we are > thinking about requiring the member id and date of service which are both > required for the 837 so should be known. For those using services we are > floating a few other ideas to keep the inquiry restrictive: > > - Questionable use of REF qual 1K. Payer claim number is useless and > unknown. The annotation points to the submitters claim number from > 837-CLM01. If we require either the CLM01 value or the patient ID number > for a date or restricted date range we can assure <99. > > - Require the patient's ID from the 837. > > - In the TPA or partner specific companion document (imp guide) note that if > they get 99 there's a good chance there are some missing. > > If your realtime is a DDE the concepts will still be similar because the > content is the same. > > -----Original Message----- > From: Martin Scholl > To: [EMAIL PROTECTED] > Sent: 6/26/02 10:25 AM > Subject: Re: Real Time overflow > > I don't get your problem. > A single inquiry means a single claim? > or are you thinking of a 276 with more then 99 individual claim > inquiries? > You could limit the number of inquiries within a single 276 to 99 in a > trading partner agreement. > You could reject a 276 with more then 99 claim inquiries based on this > agreement. > > Or are you thinking about a 277 with more then 99 STC segments? > > Martin Scholl > Scholl Consulting Group, Inc. > 301-924-5537 Tel > 301-570-0139 Fax > [EMAIL PROTECTED] > www.SchollConsulting.com > > > ----- Original Message ----- > From: "Bradford, Ryan D" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Wednesday, June 26, 2002 9:30 AM > Subject: Real Time overflow > > > > How does one report an excess of responses from an inquiry? > > > > We are building a real time solution for the 276/277 transaction. We > are > > using a Web page for a real time application and would limit the > number of > > responses to a single inquiry to 99. We can control this through the > web > > environment, but how do we let the Trading Partner know that there > were > more > > the 99 responses within the 277? I have searched everywhere and can > not > come > > up with any ideas. All responses are appreciated. Thank you. > > > > > > Ryan Bradford > > EDS - Provider Services > > 155 Federal Street, 6th Floor > > Boston, MA 02110 > > > > * phone: +01-617-350-8073 > > * fax: +01-617-350-8180 > > * mailto:[EMAIL PROTECTED] > > > > > > > > > > > > ********************************************************************** > > To be removed from this list, send a message to: > [EMAIL PROTECTED] > > Please note that it may take up to 72 hours to process your request. > > > > ====================================================== > > The WEDI SNIP listserv to which you are subscribed is not moderated. > The > discussions on this listserv therefore represent the views of the > individual > participants, and do not necessarily represent the views of the WEDI > Board > of Directors nor WEDI SNIP. 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If you wish to receive an > official opinion, post your question to the WEDI SNIP Issues Database at > http://snip.wedi.org/tracking/. > Posting of advertisements or other commercial use of this listserv is > specifically prohibited. > > > > The contents of this e-mail are intended for the named addressee only. It > contains information that may be confidential. Unless you are the named > addressee or an authorized designee, you may not copy or use it, or disclose > it to anyone else. If you received it in error please notify us immediately > and then destroy it. > > > > ********************************************************************** > To be removed from this list, send a message to: [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. > > ====================================================== > The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. > Posting of advertisements or other commercial use of this listserv is specifically prohibited. > ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. 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