Just to be on the safe side, we'd better stick to Betty Boop and forget Betty Grable. I'm guessing that post humous PHI is litigious territory too ;-)
>>> "Koller, Greg" <[EMAIL PROTECTED]> 03/27/03 04:15PM >>> Gee, is fictitious data PHI? -----Original Message----- From: McDaniel, Laurie [mailto:[EMAIL PROTECTED] Sent: Thursday, March 27, 2003 2:23 PM To: WEDI SNIP Transactions Workgroup List Subject: RE: 4010 837I compliance issue But obviously fictitious data. -----Original Message----- From: Doug Fielding [mailto:[EMAIL PROTECTED] Sent: Thursday, March 27, 2003 2:19 PM To: WEDI SNIP Transactions Workgroup List Subject: RE: 4010 837I compliance issue Nice broadcasting of PHI -----Original Message----- From: Bill [mailto:[EMAIL PROTECTED] Sent: Thursday, March 27, 2003 12:48 PM To: WEDI SNIP Transactions Workgroup List Subject: 4010 837I compliance issue Hi, Here is a breakdown of what I found with a compliance failure with the 4010 837I The error is (CLM/02 != SUM(SV2/03)) . This is in LX*5 in bold below the 37th iteration of loop 2000B (Subscriber HL). CLM02=5488.02 and the amounts of SV203 total 7927.02. This is a difference of 2439.00, which is the exact amount of this SV2: SV2*0300*HC:88180:91*2439*UN*3**2439~ SV2-01=0300 Revenue Code SV2-02-01=HC Healthcare (service) SV2-02-02=88180 Service ID/Product ID SV2-02-03=91 Procedure Modifier SV2-03=2439 Monetary Amount SV2-04=UN Unit SV2-05=3 Quantity SV2-06=<empty> Unit Rate SV2-07=2439 Monetary Amount The key here is that SV2-07 is "Line Item Denied Charge or Non-Covered Charge Amount" which nullifies the amount in SV2-03. There is nothing in the IG that states that denied charges should be subtracted from CLM02 or that SV2-03 amounts should subtract SV2-07 from SV2-03 prior to adding them for CLM reconciliation. This would appear to make sense logically but there are no business cases or documentation within HIPAA to support this theory. Can anyone supply me with an Industry Wide business case to prove otherwise? If not I then can't escalate this compliance failure to development because the software vendor feels that the map is functioning within HIPAA guidelines. here is the whole claim thanks Bill Swaney HIPAA Consultant CLM*5006902851*5488.02***13:A:1*Y**Y*Y*********Y~ DTP*096*TM*0000~ DTP*434*RD8*20021007-20021007~ DTP*435*DT*200210070600~ CL1*3*1*01~ REF*EA*315470~ HI*BK:2893*BJ:2893~ HI*BF:2141*BF:V1079~ HI*BR:4023:D8:20021007~ HI*BQ:863:D8:20021007~ HI*BE:17:::27.02*BE:A2:::498.63~ NM1*71*1*GRABLE*B****24*123456789~ PRV*AT*ZZ*203B00000N~ REF*1G*E60251~ NM1*72*1*GRABLE*B****24*123456789~ PRV*OP*ZZ*203BS0100Y~ REF*1G*E60251~ NM1*73*1*GRABLE*B****24*123456789~ PRV*PE*ZZ*203B00000N~ REF*1G*E60251~ SBR*P*18**MEDICARE A*****MA~ CAS*CO*70*27.02**A2*1794.73~ CAS*OA*96*2439~ CAS*PR*2*498.63~ AMT*C4*755.66~ AMT*B6*5488.02~ AMT*T3*7927.02~ AMT*N1*755.66~ AMT*B1*755.66~ AMT*A8*2439~ AMT*YT*2439~ DMG*D8*19401211*F~ OI***Y***Y~ NM1*IL*1*GEDDY*ESTELLE*L***MI*010327595A~ N3*54 OAK AVE APT~ N4*FITCHBURG*MA*014203138~ NM1*PR*2*ASS HOSP SVC 81*****PI*00181~ N3*2 GANNETT DRIVE~ N4*SOUTH PORTLAND*ME*041066911~ DTP*573*D8*20021106~ REF*F8*1229630223~ NM1*71*1~ REF*1G*E60251~ NM1*72*1~ REF*1G*E60251~ LX*1~ SV2*0250*HC:LMNOP*4.02*UN*3~ DTP*472*D8*20021007~ SVD*00181*0**0250*3~ DTP*573*D8*20021106~ LX*2~ SV2*0258*HC:LMNOP*17*UN*1~ DTP*472*D8*20021007~ SVD*00181*0**0258*1~ DTP*573*D8*20021106~ LX*3~ SV2*0270*HC:LMNOP*297*UN*1~ DTP*472*D8*20021007~ SVD*00181*0**0270*1~ DTP*573*D8*20021106~ LX*4~ SV2*0271*HC:LMNOP*45*UN*1~ DTP*472*D8*20021007~ SVD*00181*0**0271*1~ DTP*573*D8*20021106~ LX*5~ SV2*0300*HC:88180:91*2439*UN*3**2439~ DTP*472*D8*20021007~ SVD*00181*0*HC:88180:91*0300*3~ CAS*OA*96*2439~ DTP*573*D8*20021106~ LX*6~ SV2*0310*HC:88304*201*UN*3~ DTP*472*D8*20021007~ SVD*00181*29.78*HC:88304*0310*3~ CAS*PR*2*34.97~ DTP*573*D8*20021106~ LX*7~ SV2*0360*HC:11402*598*UN*1~ DTP*472*D8*20021007~ SVD*00181*74.43*HC:11402*0360*1~ CAS*PR*2*42.9~ DTP*573*D8*20021106~ LX*8~ SV2*0360*HC:11402*598*UN*1~ DTP*472*D8*20021007~ SVD*00181*74.43*HC:11402*0360*1~ CAS*PR*2*42.9~ DTP*573*D8*20021106~ LX*9~ SV2*0360*HC:12032*598*UN*1~ DTP*472*D8*20021007~ SVD*00181*40.55*HC:12032*0360*1~ CAS*PR*2*22.82~ DTP*573*D8*20021106~ LX*10~ SV2*0360*HC:38525*1196*UN*1~ DTP*472*D8*20021007~ SVD*00181*509.45*HC:38525*0360*1~ CAS*PR*2*355.04~ DTP*573*D8*20021106~ LX*11~ SV2*0370*HC:LMNOP*559*UN*1~ DTP*472*D8*20021007~ SVD*00181*0**0370*1~ DTP*573*D8*20021106~ LX*12~ SV2*0710*HC:LMNOP*1375*UN*1~ DTP*472*D8*20021007~ SVD*00181*0**0710*1~ DTP*573*D8*20021106~ HL*56*53*22*0~ SBR*S*18*M02111001******ZZ~ NM1*IL*1*BAEZ*JOAN****MI*011247822A~ N3*406 ELM ST~ N4*FITCHBURG*MA*014206726~ DMG*D8*19310716*F~ NM1*PR*2*MEDICAID*****PI*M02111001~ N3*600 WASHINGTON ST.~ N4*BOSTON*MA*02111~ _____ Do you Yahoo!? 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