It would appear to me that option 2 would be correct. As I read the IG, it
says that the claim information can be given in either the subscriber HL or
the dependent HL. I would not expect to find the CLM loop in both.
"Goetz, John"
<[EMAIL PROTECTED] To: "WEDI SNIP Transactions
Workgroup List"
s-inc.com> <[EMAIL PROTECTED]>
cc:
03/20/2003 Subject: 837 Subscriber and Patient
Loops
12:30 PM
Please respond
to "Goetz,
John"
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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