Local codes should not be used in compliant 837 claims transmissions. That being said, local modifers will be used by some carriers regardless of compliance and you will need to use them to get claims approved for payment. Many on the modifiers are actually part of the standard, but "oddballs" and will get kicked by some of the self named certification services (GY is one of these we've come across); that's the reason for the trading partner testing. This is the one that gets the claims paid. We went with certification from our trading partner's IT dept and left it with that. The other partners have yet to come up to speed and so far all will be OKing transactions on the acceptance of the others, or via the commercial certification service. We've been comfortable knowing that the claims we send will be accepted and processed according to the insurance receiving translation algorithm. Is it HIPAA compliant? Who knows, but if it's OK with CMS, I figure we've got some ground to stand on there. Just my 2 cents worth.
On Mon, 21 Oct 2002 16:12:21 -0700 "Deanna Braun" <[EMAIL PROTECTED]> writes: > > > We are currently sending 3051 claims with "local" modifiers for some > procedures in the SV1 segment. > > We are in the process of testing 4010 and our certifying authority > is rejecting the local codes. > > Is it true that sending these code will be considered non-compliant? > > > Thanks for your help. ________________________________________________________________ GET INTERNET ACCESS FROM JUNO! Juno offers FREE or PREMIUM Internet access for less! Join Juno today! For your FREE software, visit: http://dl.www.juno.com/get/web/. ********************************************************************** 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.
