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Kathy,
I believe you would, if the claim passes syntax
muster.
The issue of how you report claim-level syntax problems is
rather up in the air. You can use a 997 to reject the whole transaction;
the 277 ack would seem to be the proper place to report claim-level syntax
problems, but at least some clearinghouses generate a print-image
report.
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]
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----- Original Message -----
Sent: Friday, March 14, 2003 12:31
PM
Subject: RE: Claim Denials
Thanks, Doug. This helps clarify the "request for information
piece." Let me narrow the question from the provider side.
If
the provider requests it, is the payer required under HIPAA to send denials
through an 835?
Thanks for your help.
Kathy
Cathy,
Not yet. The unsolicited and claim acknowledgment
versions of the 277 haven't been made a HIPAA standard
yet.
You can use them if you and your trading partners
agree. You might also agree that the 277 requests for additional info
replace the paper requests.
You have to send a 835 if the provider requests it (this
could be either in place of or in addition to your paper EOB).
If you are responding to a 276, you would have to respond
with a 277 indicating the current claim status.
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 -----
Sent: Friday, March 14, 2003 11:25
AM
Subject: Claim Denials
Hi All,
Are all payers required to send denials
through an 835 ERA and requests for
information through a 277, so can
they still send letters denying claims or
asking for additional
information before they will pay the claim.
Thanks for your
help.
Kathy Carlin
Siemens Medical
Solutions
610-219-2067
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