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Tom,
I stand corrected. I had overlooked the SBR02
problem.
Supposedly, then, the Subscriber could have any number of
Patients, so long as one of them is not himself. (I think the IG guys didn't
intend this effect, but it's there, so...).
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: Thursday, March 20, 2003 01:02
PM
Subject: RE: 837 Subscriber and Patient
Loops
Option two is the only correct option.
There is a conflict
with SBR02 (Relationship Code) in the 2000B loop.
It is situational with
the following note:
"Required when the subscriber is the same person as
the patient. If
the subscriber is not the same person as the patient, do
not use
this element."
In order to satisfy the above requirement,
you must repeat the
subscriber information.
Hope this
helps.
Tom Drinkard
EDIT, Inc.
[EMAIL PROTECTED]
(678)
795-1251 (voice)
(775) 458-6117 (fax)
-----Original
Message-----
From: Goetz, John [mailto:[EMAIL PROTECTED]
Sent:
Thursday, March 20, 2003 1:31 PM
To: WEDI SNIP Transactions Workgroup
List
Subject: 837 Subscriber and Patient Loops
I have a question
regarding subscriber and patient loops in the 837. If
a healthcare
provider bills claims for both the subscriber and the
subscriber's
dependent in the same 837, how should the subscriber and
patient loops be
arranged?
Option 1
2000B - SUBSCRIBER HIERARCHICAL
LEVEL
2010BA - SUBSCRIBER NAME, ADDRESS, DEMOGRAPHIC
2010BB - PAYER
NAME
2300 - CLAIM INFORMATION
2000C - PATIENT HIERARCHICAL
LEVEL
2010CA - PATIENT NAME, ADDRESS, DEMOGRAPHIC
2300 - CLAIM
INFORMATION
Option 2
2000B - SUBSCRIBER HIERARCHICAL
LEVEL
2010BA - SUBSCRIBER NAME, ADDRESS, DEMOGRAPHIC
2010BB - PAYER
NAME
2300 - CLAIM INFORMATION
2000B - SUBSCRIBER HIERARCHICAL
LEVEL
2010BA - SUBSCRIBER NAME, ADDRESS, DEMOGRAPHIC
2010BB - PAYER
NAME
2000C - PATIENT HIERARCHICAL LEVEL
2010CA - PATIENT NAME, ADDRESS,
DEMOGRAPHIC
2300 - CLAIM INFORMATION
In option 1, the patient
hierarchical level starts immediately after the
subscriber's claim
data. In option 2, the subscriber level must be
repeated after the
subscriber's claim data and before the dependent's
claim data. Which one is
the correct option when a provider submits
claims for both the subscriber
and the subscriber's dependent in the
same 837?
Thank
you,
John Goetz
HIPAA Project Manager
ACS State
Healthcare
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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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