Re: TRANSACTION QUESTION

[Doug Webb]

Greg, If the provider generates a new claim with the corrected info, there should be no problem.   If the payor creates a new claim, I think there would be trouble, since the provider has already processed the denial.  >From a 835 for a new claim generated by the payer, a provider would have no way of knowing that the effect of the previous denial had to be reversed before posting the re-adjudication.  Also, the 835 would have to refer back to the original provider-supplied values that it has to echo, making it half a reconsideration, and half a new claim -- a very confusing situation.  Technically, you might be able to send a complient transaction, but the transaction does not convey the proper business information.   If it revisits the same claim, with the appropriate correctons and CAS segments to reverse the effect of the original 835, and then paying (rather than denying), all would be OK.   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: Bard, Greg To: WEDI SNIP Transactions Workgroup List Sent: Thursday, March 20, 2003 12:44 PM Subject: TRANSACTION QUESTION If a payer rejects an original claim as submitted by the provider because an incorrect prefix on the SSN was submitted and the system subsequently generates a new claim with the corrected SSN and prefix and generates an 835 based on the corrected information, is the health plan in compliance?   Thanks!     Greg Bard NASCO HIPAA Privacy and Security Project Manager (W) 678.441.6059 (F)  678.441.6359 [EMAIL PROTECTED]     ______________________________________________________________________________________ CONFIDENTIALITY NOTICE The information in this message (and the documents attached to it, if any) is confidential and may be legally privileged. It is intended solely for the addressee. Access to this message by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken, or omitted to be taken in reliance on it is prohibited and may be unlawful. If you have received this message in error, please delete all electronic copies of this message (and the documents attached to it, if any), destroy any hard copies you may have created and notify me immediately. Thank you.           --- 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-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/. 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-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