Deborah,
X12N has, as one example, an Eligibility Roster Implementation Guide,
number X040, based solely on the 271 Transaction Set, that describes
an unsolicited message. It's available at www.wpc-edi.com for
voluntary use -- as are numerous other X12N Implementation Guides that
have not been adopted [yet?] for HIPAA.
It's a bigger world out there than we often imagine. Enjoy.
Dave Feinberg
Rensis Corporation [A Consulting Company]
206-617-1717
[EMAIL PROTECTED]
----- Original Message -----
From: "Sparma, Deborah, nashccon"
<[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Thursday, September 19, 2002 10:00 AM
Subject: Capitation payments and the 835 and 271
I am trying to figure out the intended use of the wording in the 835
IG front matter where it says the following:
"The 835 is used to provide financial notification of capitation
payments from a Managed Care Organization (MCO) to a capitated care
provider. The 835 does not contain the capitation details or
membership roster. Use an associated Eligibility and Benefits
Notification Transaction Set (271) to communicate these details.
Capitation payments may be included with claims payment information in
a single 835 or they may be passed alone. In either case, the existing
balancing process for the 835 applies."
Is this implying that a 270 has to be sent for every occurrence at the
member level since there is no 271 unsolicited? Has anyone considered
using this process? If so, how?
Thanks,
Deborah Sparma
Datateck Consulting Group
[EMAIL PROTECTED]
(303) 534-0109
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