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William,
I'm with you on this one.
If they wanted to be totally unambiguous, they could state
"The same person as the patient referred to in the 2300 loop that immediately
follows" To my simple mind, what's there implies this.
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 21, 2003 01:16
PM
Subject: Re: 837 Subscriber and Patient
Loops
I'm left knocking my head figuratively against the wall on this
one!
I don't see how the note on SBR02 keeps you from using John
Goetz'
"Option 1," whereby a subscriber has both claims itself along
with
subordinate "patients" (or dependents) with claims. The note says
SBR02
is "Required when the subscriber is the same person as the
patient..."
Is it just a matter of a definite vs. an indefinite article? -
i.e.,
"same person as *the* patient" vs. "same person as *a* patient."
That's
getting really obtuse, if so.
I simply read "same person as
the patient" to mean that a 2300 claim
loop is included within the 2000B
Subscriber HL - nothing more or less.
It certainly can't mean the 2000B
Subscriber HL is the same as the 2000C
Patient HL, which would be the
literal interpretation of the note - and
which is also patent nonsense! If
there are claims in the 2000B
Subscriber loop, the subscriber is *the*
patient. Period. It hardly
matters that there are other patient (or
dependent) HLs subordinate to
the subscriber HL - that's an entirely
separate issue (and loop).
I can't see how it's any harder for a payer
to process either "option."
A payer would probably have had to actually
work at it to make Option 1
not work! Nor does there seem to be anything
wrong with either the
front-matter or the notes as they are
now.
William J. Kammerer
Novannet, LLC.
Columbus, US-OH
43221-3859
+1 (614) 487-0320
----- Original Message -----
From:
"Tom Drinkard" <[EMAIL PROTECTED]>
To:
"WEDI SNIP Transactions Workgroup List"
<[EMAIL PROTECTED]>
Sent:
Thursday, 20 March, 2003 03:44 PM
Subject: RE: 837 Subscriber and Patient
Loops
Ed,
We disagree.
The front matter in the
implementation guides (all three guides
illustrate option one) will be
corrected for version 4050. In the
meantime, I would suggest that those
entities who submit claims only use
option two, since it will be compliant
in all cases. It would be nice if
those entities who receive claims support
both options, since that will
optimize the transaction flow, but that is
wishful thinking.
This discrepancy has been discussed at length by the
837 workgroup at
X12N. The conclusion of the group is that the front matter
is incorrect
and the pages in the transaction listing (Section 3) is the
only
technically correct option.
Hope this helps.
Tom
Drinkard
EDIT, Inc.
[EMAIL PROTECTED]
(678)
795-1251 (voice)
(775) 458-6117 (fax)
-----Original
Message-----
From: Ed Stroot [mailto:[EMAIL PROTECTED]
Sent:
Thursday, March 20, 2003 3:35 PM
To: Tom Drinkard; WEDI SNIP Transactions
Workgroup List
Subject: RE: 837 Subscriber and Patient
Loops
Tom,
I beg to differ. Both options are correct. Option
1 is described exactly
in the front matter for the 837P (see 2.3.2.1, the
HL example for
SUBSCRIBER #4 AND PATIENT #P4.1). Option 1 is not usually
used, but is
correct. We see it used for dental claims. It took some work
by my
developer, but he figured out how to keep it all straight.
Ed
Stroot
-----Original Message-----
From: Tom Drinkard
[mailto:[EMAIL PROTECTED]
Sent: Thursday, March 20, 2003
1:02 PM
To: WEDI SNIP Transactions Workgroup List
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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