Pat, I don't have any idea of where these "extensions" to the 7 types of testing are coming from. Not from Claredi. Perhaps someone thinking outside of the box?
Kepa On Friday 15 November 2002 02:15 pm, Patricia Hamby wrote: > When did a level 8 come into existence? Are these the Claredi levels? > Level 7 was trading partner. If there is a level 8, would someone please > send me a link? Thanks! > > Patricia Hamby > HIPAA Compliance Project Manager > XANTUS Healthplan of Tennessee, Inc. > (615) 463-1612, office > (615) 279-1301, facsimile > > -----Original Message----- > From: Thaler, Patrice M [mailto:Patrice.Thaler@;allina.com] > Sent: Friday, November 15, 2002 11:55 AM > To: WEDI SNIP Testing Subworkgroup List > Subject: RE: Payer Edits (Type 7 or 8) > > > > I have heard of provider edits. In our collaborative we have provider edits > in our 835 companion guide. > > I want to be clear that I was extremely nervous about creating companion > guides. I am a believer in STANDARDS. but I hope you can see by reading the > examples below our payers are not changing the standards - just helping > providers (or payers) know their logic. Does anyone think these are changing > the standard? > > Here are sample edits for the 837 Professional Claim > > REF02 Prior Authorization or Referral Number 2300 > *If number is incorrect, the data will be dropped and the auto match process > in our claims processing system will obtain the correct number. > > NM1RENDERING PROVIDER NAME 2310B > *Required for all providers. > *If not submitted billing provider will be used in adjudication. > *Required if different from billing/pay-to provider. > *Application rejects if claim does not contain rendering information in one > of the provider loops. > *Required if different from Billing Provider (Loop 2010A) > *Required if different from Billing Provider (Loop 2010A) > > -----Original Message----- > From: William J. Kammerer [ mailto:wkammerer@;novannet.com > <mailto:wkammerer@;novannet.com> ] > Sent: Friday, November 15, 2002 11:30 AM > To: WEDI SNIP Testing Subworkgroup List > Subject: Re: Payer Edits (Type 7 or 8) > > > 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 > <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. 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