Patrice, Type 7 is still payer-specific but is only those specific payers that are mentioned in the guides. I guess they are the ones who had a voice in the meetings where the standards were developed. Any other subset of the rules need to be edited once the transmission is let into the application. It is against the HIPAA guidelines to reject something that does follow the IG guidelines. However, they can deny the claim or whatever once it is in their application if it does not contain the data the application is expecting. Does that make sense?
_______________________________________________ John Lilleston Technical Supervisor Verizon Information Technologies, Inc. Healthcare Solutions 813-979-3225 [EMAIL PROTECTED] http://www.VerizonIT.com/ _______________________________________________ "Thaler, Patrice M" To: "WEDI SNIP Testing Subworkgroup List" <Patrice.Thaler@a <[EMAIL PROTECTED]> llina.com> cc: Subject: RE: Payer Edits 11/15/2002 09:22 AM Please respond to "WEDI SNIP Testing Subworkgroup List" My example is this: Payer A requires me to use code "55" in a particular data element. Payer B requires me to use code "66". Both are codes offered in the guide for that data element. They will reference their choices in their specific payer companion guides. Would those be type 2 edits? My dilemma is this: We are offering a tool for our community for what has been called type 6 edits that matches all code choices in the guides. Some payers are creating companion guides for rules as mentioned above. How do I explain to the community that first they are testing against the broad type 6 edits, then they can test with a specific payer guide for the edit I mentioned above? Maybe I do not have to call it any type?...but this is getting confusing since Type 7 in the past have been referred to as payer specific. Thank you Patrice -----Original Message----- From: Kepa Zubeldia [mailto:Kepa.Zubeldia@;claredi.com] Sent: Thursday, November 14, 2002 5:56 PM To: WEDI SNIP Testing Subworkgroup List Subject: Re: Payer Edits Patrice, I have a different opinion. Some payer specific edits refer to situational edits (type 4) or to line of business specific edits (type 6) or even to limitation on syntactical requirements such as limits on loop counts or requiring specific provider IDs that would fit within the definition of type 2 edits. So the fact that they are payer specific does not make them into a type 8 vague group. My interpretation is that there are "HIPAA requirements" and "payer specific requirements" and both types can be divided into the same types 2-6. Type 1 is X12 syntax and the payers cannot define that. Then type 7 in the "HIPAA requirements" are payer specific requirements defined in the implementation guide, such as Medicare, Medicaid and Indian Health. A payer specific requirement that does not fit within the "payer specific types 2-6" would be a "payer specific type 7" sort of edit. So, as I understand it, there is no type 8. Does this make sense? Kepa On Thursday 14 November 2002 10:30 am, [EMAIL PROTECTED] wrote: > Patrice, > > Yes...any payer edits that are not mentioned in the X12N implementation > guides would be referred to as the next type of testing. Our plans are to > delve more into that subject in the Business to Business Testing white > paper. > > _______________________________________________ > > John Lilleston > Technical Supervisor > Verizon Information Technologies, Inc. > Healthcare Solutions > 813-979-3225 > [EMAIL PROTECTED] > http://www.VerizonIT.com/ > _______________________________________________ > > > > "Thaler, Patrice > M" To: "WEDI SNIP Testing Subworkgroup List" > <Patrice.Thaler@a <[EMAIL PROTECTED]> > llina.com> cc: > Subject: Payer Edits > 11/14/2002 12:26 > PM > Please respond to > "WEDI SNIP > Testing > Subworkgroup > List" > > > > > > > There are some payers that are developing their own companion guides and we > will be testing against them with a tool prior to direct testing. Would we > call this "Type 8" testing? > > > Patrice Thaler > Allina Hospitals and Clinics > HIPAA Project Manager > Phone: 612-775-9705 > Pager: 612-654-3066 > Fax: 612-775-9715 --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-testing as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-testing as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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/. 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