Perhaps Ed was just being circumspect. Indeed, all partner specific edits I've ever heard of are "payer-specific." Has anyone ever heard of a provider mandating specific things a payer is to send to her (say, in the 835 or 277)? Hence, "payer-specific" is far more honest.
Can someone provide concrete examples of these "payer-specific" edits? - And how they might be phrased in a "companion" guide? You know, I can imagine things like a payer saying "we need the plan ID for the subscriber in order to process the claim, and our plan numbers look like this..." Or "we just use the first 4 diagnosis codes you might specify." And maybe even parenthetically, the payer could say where these things occur by loop, segment and element. But if the "companion guide" starts to look like a duck, quack like a duck, and waddle like a duck - it probably is a duck, i.e., an "implementation guide." Then its legality is problematic. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Rishel,Wes" <[EMAIL PROTECTED]> To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> Sent: Friday, 15 November, 2002 11:33 AM Subject: RE: Payer Edits (Type 7 or 8) 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 --- 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
