I don't know the history on this, but if I am a provider sending to a clearinghouse, and the clearinghouse is adding edits beyond the IG, it is doing so on behalf of the payer.
Since the same clearinghouse will enforce different edits on behalf of different payers, "payer-specific" seems more to the point. -----Original Message----- From: Ed Hafner [mailto:ehafner@;foresightcorp.com] Sent: Friday, November 15, 2002 8:00 AM To: WEDI SNIP Testing Subworkgroup List Subject: RE: Payer Edits (Type 7 or 8) Rama, Partner specific is a term I pulled out of the IG and even there it infers that most partner specific edits are initiated by the payer. So you can really group our terms together. I was being a little more formal in respect to the guides. Only the explicitly documented edits in the IGs today (Medicare, Medicaid, and Indian Health) are being considered type 7. All other partner/payer specific edits outside the guides are not considered type 7. This conversation on what to call these edits leads to one of the reasons for enhancing the B2B testing paper. Not to confuse the issue, these partner/payer specific edits really could be of any type referring to Kepa's response (e.g. data code lookup(5), specialty edit(6), health care conditional logic(4)). Hope that helps, Ed Edward A. Hafner Chief Technology Officer Foresight Corporation +1.614.526.4328 -----Original Message----- From: [EMAIL PROTECTED] [mailto:ramkrisp@;onebox.com] Sent: Friday, November 15, 2002 10:41 AM To: WEDI SNIP Testing Subworkgroup List Subject: RE: Payer Edits (Type 7 or 8) More from my 'recollection'... when 'Levels' were changed to 'Types' and when Type 7 was added... to cover special things for special payers like Medicaid, Medicare, Indian Medicine etc.,... Ed Hafner was using the term 'PARTNER SPECIFIC' when Kepa and some others were using 'PAYER SPECIFIC'. Can type 7 can be both in some sense? It was suggested then that 'PAYER SPECIFI' Type 7 things will need to be tested for all Types 1 through 6. Ed, Kepa, please correct me if my referring to your reminalogy is wrong. Back to Cynthia's more accurate recollection... that 'partner specific' sfuff will be or should be covered in B2B Testing white paper. The reason, again from my recollection, is that 'PAYER SPECIFIC' stuff may not go into Companion Guides and TPAs but "PARTNER SPECIFIC" do. Others who recollect this differently/better or phrase it better, please help out. Thanks. I do not beleive I am answering Patrice's question. But recollecting the thought process the group went through then (June, 2002?)... Regards, -Rama. -----Original Message----- From: Herb Larsen <[EMAIL PROTECTED]> Sent: Fri, 15 Nov 2002 09:38:41 -0500 To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> Subject: RE: Payer Edits My own sens is that Types 1-6 correspond to the former levels 1-6 from the Testing White Paper. Type 8 is no longer what used to be known as Level 7, which, from marketing literature among vendors,was broadly defined as payer-specific, as in the example below, to be tested in the B2B testing between the trading partners. Type 7 is actually the "codified in the IG" payer specifics, like Medicare, Medicaid and Bureau of Indian Health Affairs, and Type 8 is now the "non-codified" trading partner specifics. Thoughts? -----Original Message----- From: Thaler, Patrice M [mailto:Patrice.Thaler@;allina.com] Sent: Friday, November 15, 2002 9:23 AM To: WEDI SNIP Testing Subworkgroup List Subject: RE: Payer Edits 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. 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