Encounters to whom? The regs do list it as the format for both claims and encounter data.
- For encounter data from a provider to a payer we say yes.
- If you are an MCO working with Medicare (an M+ Choice plan) the answer is no. CMS is now requiring "data to support risk adjustment" and are asking for about 6 fields of data. They will accept the 837 if you want to send it or your current NSF format or their new format.
- If you are reporting encounter data to a Medicaid agency the answer is maybe, ask their fiscal intermediary. About 1/2 the state Medicaid programs are asking for the 837 and about 1/2 are not.
Kris Owens
Senior IS Project Manager - HIPAA Project
Presbyterian Healthcare Services
Albuquerque, NM
505.923.8108
[EMAIL PROTECTED]
"Complex systems evolve from simple rules"
-----Original Message-----
From: Goldman, Shellie [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, July 17, 2002 11:10 AM
To: '[EMAIL PROTECTED]'
Subject: Encounter Data
Is the 837 transaction set required for encounter data? I cannot find
anywhere in the regs that indicate it is not. If you have the site in the
regs, please let me know.
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