The biggest problem that I see in mapping from a non-standard claim format to the 837 is going to be this "gap data"... information required in the standard but not present in the old transaction data set. The Aspire project (focused on the "1500") and some related efforts focused on UB92 and NSF formats, have highlighted all of these potential gap-elements. Now, I think we have a need to further refine these to see which gap elements are related to [relatively stable] provider information such as taxonomy and which elements are related to the patient or the specific service scenario... as in this chiropractic example.
Providing a DB table to hold the stable "provider" gap data (either locally or at a cooperative CH) would be an easy fix. But if a certain type of provider needed to include patient information that varied with every claim... or if the situational logic actually changed the "required vs. not-used" status of elements on a claim-by-claim basis... then we'd have a much more challenging situation, that a CH would clearly NOT be in a position to handle. Providers in these situations had better start leaning heavily on their PMS vendors to add fields and or logic to the claim-creation process, so that all required gap elements are covered on every possible claim scenario.
Or... Plan B: drop to paper!
Regards,
-Chris
Christopher J. Feahr, OD
Optiserv Consulting
[For the vision care industry]
Santa Rosa, CA
707-579-4984
707-529-2268 (cell/pager)
http://VisionDataStandard.org
http://Optiserv.com
At 07:44 PM 10/11/2002 -0700, Chris Baker wrote:
Art, This is a really good question. I have been pondering this for some time. I have been consulting on the provider and payer side and frankly, I think the issues comes down to this:If the business practices of a payer require certain information for some claims type, they can or will pend the claim and send a 277 for additional information. If they do not care, they will pay the claim (or not for other reasons). My company is working with providers (and payers) that have systems (mostly practice management systems) that only print HCFA-1500's. We are left with the problem of providing these folks with the other (possibly required) data elements with via a second application where the biller can enter them manually from the chart or fee ticket. I'd love to know what other folks are doing with this... -----Original Message----- From: Art Schenkman [mailto:ArtS@;SchallerAnderson.com] Sent: Friday, October 11, 2002 2:49 PM To: '[EMAIL PROTECTED]' Cc: Anne Romer Subject: Missing Elements on an HCFA 1500 How are health plans accommodating the required 837 Professional elements that can not be obtained from a paper claim? ambulance services, spinal manipulation, pregnancy For example, If a chiropractor does a spinal manipulation, we would expect him to submit his bill on a HCFA 1500 claim form For spinal manipulation, there are several required fields within the 837. Within the 2300 loop CR2 detail (Spinal Manipulation Service Information), the following information is required and can not be found on a paper claim: Treatment Series Number, Treatment Count, Subluxation Level Code, Treatment Period Count Monthly Treatment Count, Patient Condition Code, Complication Indicator For ambulance transports, loop 2300 detail CR1 (Ambulance Certification), required and not on a paper claim Ambulance Transport Code, Ambulance Transport Reason Code. For obstetrical claims, the paper claim provides the last menstrual cycle date but not the estimated date of birth. We are required to include this information when we submit the 837 to our state agency. Has anyone addressed and or resolved an issue similar to this? NOTE: This is a re-send of two earlier emails that have experienced receipt problems. This message is in PLAIN TEXT FORMAT ********************************************************************** 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. ********************************************************************** 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.
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