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There is no compliant way to send TOS in a 4010 or 4010A1
837 transaction. The data has been explicitly and intentionally
removed from the transaction set. Requiring a provider to include
the data in a non-compliant field is a HIPAA violation.
� 162.915 Trading partner
agreements.
A covered entity must not enter
into a trading partner agreement that would do any of the
following:
(a) Change the definition, data
condition, or use of a data element or segment in a
standard.
(b) Add any data elements or
segments to the maximum defined data set.
(c) Use any code or data
elements that are either marked ��not used�� in the standard�s implementation
specification or are not in the standard�s implementation specification(s).
(d) Change the meaning or intent
of the standard�s implementation specification(s).
Cathy Sheppard
----- Original Message -----
Sent: Friday, March 21, 2003 10:16
AM
Subject: Re: Type of Service still
needed?
Stacy,
Try this on for size...(I don't particularally like it, but
it may be complient)
Make the TOS value (2 characters, using the codes from NSF)
the first 2 characters of a line-level (Loop 2400) REF with REF01=G1 (Prior
Authorization).
Since line-level Prior Authorizations are rare (usually
Claims are authorized, not lines), in most cases it could be the only 2
characters in that field. If it isn't, append the real line-level Prior
Authorization to the TOS (or the payer could issue a line-level Prior
Authorization that happens to start with the TOS -- that would simplify the
necessary logic -- use the TOS as line level Prior Authorization unless there
is a code from the payer).
I don't see any other complient way.
It looks like that if the value is really needed, SV106 is
the place it really should be put (it was TOS before it was eliminated in
4010), but I don't see any way this can be changed before 4050, and until
that time, putting something there is non-complient.
Whatever happens, we need a consensus as to what to
do. Everybody wanting something different defeats the entire
purpose of standardization.
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 02:40
PM
Subject: RE: Type of Service still
needed?
I
have been asked to add this information to lots of areas - all of which I am
extremely leery of implementing past 10/16/03.
One of the proposed "fixes" for this issue was to
request of us to send the TOS in a REF segment in the 2400 loop which the
payer has interpreted as "able to be used at their
discretion" - although the qualifier would really not apply to the
information in the segment, so I'm not sure that's a good idea.
It has also been requested of us to send this info as
a line note in the 2400 loop, but that concerns me because it would override
any possibility of a true line note.
Another request was asking us to send it in the line
item control number REF segment in the 2400 loop, but that's not an option
either in my opinion because payers are required to return this number in
the remittance advice transaction (835) if the providers sends it to them in
the 837.
Most commonly, we
are being asked to send the TOS in SV106.
Is there really any
way for payers to be able to get around rewriting their adjudication
systems if they are currently dependent on
type of service?
Stacy M. Trease
EDI Programmer/Analyst, Gateway EDI Inc.
Co-Chair, MO SNIP TCS
Subcommittee
(800) 969-3666 Ext
224
[EMAIL PROTECTED]
I am just starting Medicaid programs by state for my company. Can
you tell me what Payers are requiring this information? And to what
loops and segments you are adding this information?
Any help you could provide would be
appreciated.
Tiffany Gutraj Rosik
Product Analyst
Amicore
Many
of our providers are running into the same thing, especially with the
Medicaid's. Because of edits in place today we had to add TOS to our
ANSI 4010 format. I was not aware that this requirement might extend
past October.
We
are also finding that some payors are currently requiring in the 4010
the responsible party's DOB and sex.
-----Original
Message-----
From:
Stacy Trease [mailto:[EMAIL PROTECTED]
Sent: Wednesday, March 19, 2003
2:42 PM
To: WEDI SNIP
Transactions Workgroup List
Subject: Type of Service still
needed?
Many of the
payers we have been testing with are informing us that they will
still need to receive the type of service code for claims
after 10/16/2003. In the implementation guide, SV106 is marked as
not used.
Is anyone
else running into this, and if so, how have you been handling
it?
Thanks for your
input!
Stacy M.
Trease
EDI
Programmer/Analyst, Gateway EDI Inc.
Co-Chair,
MO SNIP TCS Subcommittee
(800)
969-3666 Ext 224
[EMAIL PROTECTED]
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