In transaction 278 Request (authorization) we have
HI and UM segments to send services or diagnosis for which authorization is requested.
1) HI - Healthcare
diangnosis at subscriber HL
2) HI - Healthcare diagnosis
at dependent HL
3) HI - Healthcare diagnosis at
Service level
4) UM - At service level it
contains general code values given in HIPAA IG for 278.
Unlike HI (uses CPT, HCPCS codes), UM consists
of service type code (UM03).
As per Imp. Guide, use of HI segments
is *Situational* and use of UM is *Required*.
Further within UM, first two elements "UM01
and UM02" are mandatory.
But element that
contains general service codes "UM03" is optional.
In my view, at least at one place service info
should have been mandatory.
The situation leads to many Questions:
1) What does the request for authorization without
service info. mean? 2) How will payer process the request transaction,
if we do not send any related info in 278 request?
3) If non occurance of HI and UM03 is valid
transaction, what will the response from
Payor?
4) What should I do to send the request which
contains service info and is mandatory as per HIPAA requirement?
5) Should I make at least one of above
specified segments mandatory so that user will have to enter service info?
Any reply to this will be very helpful.
Thanks for patient reading and best regards
Deepan Vashi ********************************************************************** 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. |
