Brian, On the detail of SBR03/04, I think your reading is more common sense -- the guide's statement seems more one of exclusion than inclusion (i.e. no SBR04 when SBR03 is present, rather than SBR04 required when SBR03 absent). But you raise a larger issue--whose interpretation of the IG is correct, and through what process does the industry arrive at a consensus? I think it is concern over this that has driven discussions here on certification, and piqued our hopes that CMS will step in and clear all confusion.
Unfortunately, the testing process is starting to reveal how many different ways seemingly simple language can be interpreted. Anxiety over making deadlines, enduring audits, and the possibility of fines, etc. hasn't lessened the 'overreading' and hairsplitting that we encounter (or perpetrate...). Even worse, large entities may try to use their substantial market presence to coerce their trading partners into accepting their misreading of the guide. This will allow them to deliver a threadbare transaction, and shift the development effort onto the smaller shops who must digest it. (I have already seen this attempted.) I wouldn't expect SBR04 to be the last moving target you have to hit. Administrative Simplification ain't that simple yet. Michael Lachenmayer Lead Systems Analyst Independence Blue Cross Ph: 215.241.9453 Fx: 215.241.4239 -----Original Message----- From: Young, Brian [mailto:BYOUNG@;accu-med.com] Sent: Tuesday, October 22, 2002 10:43 AM To: '[EMAIL PROTECTED]' Subject: 837 I - SBR03/SBR04 Policy Number & Group Name Morning all, Question from an 837I tester... I have been testing with a few of CMS's FIs and have been getting different information with each test. Granted I am using data from providers that the FI would serve; but, are we still hitting a moving target? I am getting conflicting information about when to use what elements. And these testing environments one would expect to be the same. They are all CMS FIs. Case in point: I have tested with UGS and AdminaStar. Both tests have cleared front end edits and have received approval from AdminaStar for the transmission elements described above. In these 2 elements I do not supply any data as they are optional fields. I supply the Medicare policy number in the NM109 field as described in the SBR03 notes. The kicker on the latest testing, the intermediary says that one of these 2 fields is required. They are indicating that if SBR03 is empty then SBR04 must be filled. The question I have is, is this true? I read the notes from SBR04 and it reads "Used only when no group number is reported in SBR03." Now I'm not sure about their interpretation of English, but I dont see the words "must be used if" in that sentence. Am I wrong? How do I push back on this? Like I said... I feel like I have been trying to hit a moving target. And if the target is moving... then my program must move too. Now do I go back and retest? Granted its only one now... but later it could be dozens. Please excuse the small rant... but could use some help. Thx, BCY Brian C. Young Accu-Med Services Inc. An OmniCare Company Milford, OH 45150 513.831.1207 ********************************************************************** 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. CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute and delete the original message. Please notify the sender by E-Mail at the address shown. Thank you for your compliance. ********************************************************************** 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.
