Re: Gap Analysis for 837P vs HCFA 1500/NSF

[Jan Root]

Susan, UHIN has created a 'standard' crosswalk from the HCFA-1500 to the 837P that is based on the transaction rather than on what any one payer wants.  It has an appendix that lists all the data that 'falls off the form'.  If you like, I'd be happy to share that with you.  It is based on the ASPIRE project although it takes it one step further. Rather than creating a litteral crosswalk, it seeks to create a standardized print image that could be used by a print-image powered translator to create a compliant 837P transaction.  Needless to say we had to kludge it a little and it only works for very simple 'mainstream' types of claims. There are a handful of elements that are required in the 837 for which there is no home on the form.  However if a provider is not a specialist, and is sending a claim with 6 or fewer lines, and it's not to a secondary payer, (etc.etc.) it could work.  We created it for our providers so that they could do a somewhat standardized gap analysis based on their existing pm systems.  It is not based on payer needs; it is based on the implementation guide.  It is not an absolute 'standard' but it's a good place to begin. Jan Root UHIN Doug Webb wrote: Susan,By the time one of those 'For Dummies" books is written, the regs will change, even at eht glacial rate the government does things.  Unfortunately, I don't think that the thing can be simplified. With the huge numbers of Situational values in the 837 (and others), only the person who is fully familiar with the situation can make the decision whether the situation applies.  When in doubt, err on the side of sending unneeded information, since extra info just wastes bandwidth, while leaving out something the payor needs results in non-payment. The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. Webb Computer System Engineer Little Company of Mary Hospital & Health Care Centers [EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s)  named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately,  delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you."   ----- Original Message ----- From: Susan Hollabaugh To: WEDI SNIP Transactions Workgroup List Sent: Thursday, March 06, 2003 05:30 PM Subject: RE: Gap Analysis for 837P vs HCFA 1500/NSF  Brenda, I was not able to find a 'crosswalk in a box' that really met my needs as a provider. However both my software vendor and my clearinghouse helped me in my gap analysis. Each of them produced a gap analysis of the data elements that they needed to add to their products (or that I needed to add to my file) to create a 'complete' transaction.  I also used some of the other 1500-837 type crosswalks that were available to augment my gap analysis, however when push came to shove I still had to review the Professional Implementation Guide (IG) to make sure I got everything I needed. As a provider it is my responsibility to be compliant not my software vendor, so to cover all the basis, I did a complete review of the Implementation Guide. I came up with discrepancies between what I thought I would need and what my vendors thought I would need so there really is no substitute for going through the IG. Susan -----Original Message----- From: Brenda K. Burton [mailto:[EMAIL PROTECTED]] Sent: Thursday, March 06, 2003 3:03 PM To: WEDI SNIP Transactions Workgroup List Subject: Gap Analysis for 837P vs HCFA 1500/NSF     Can someone point me in the right direction...  we are a billing company and looking to find a concise, easy to understand list or gap analysis to help us understand what data elements are needed in addition to what we already collect to submit a claim. I already looked at the WPC-EDI guide and it's a bit too techy for me.  I reviewed the Proxymed HCFA 1500-837P crosswalk and found that helpful, yet still not thorough enough for my needs. So, where can I find a, excuse the term, 'dumb-it-down' version explaining this information?  For example, I understand that the "Type of Service (TOS)" code will no longer be necessary.  What will replace this if anything (a taxonomy code)? Feel free to E me off the list as well.  Thanks in advance for your help! Best, Brenda   Brenda K. 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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-transactions 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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