Doug,
What do you do with non-Claims non-Enrollment transactions like the 835s in
your scenario?
The 835 Remittance will be produced from a - let's say weekly - Claims
Financial process.
It will contain all the claims paid, denied, adjusted or voided during the
previous work week.
The dates of service will vary widely!
So if the extract has a mix of claims ... and therefore a mix of HIPAA
compliant and
non-compliant Medical Codes Set values ... won't this produce a
non-compliant 835 ?
Marsha
Verizon Information Technologies
Managed Care Division
Phoenix, AZ
Home of the Back To Back NL West Champion ARIZONA DIAMONDBACKS
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Fax - 602.678.6331
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"Doug Webb"
<[EMAIL PROTECTED]> To: "WEDI SNIP Transactions
Workgroup List"
<[EMAIL PROTECTED]>
06/02/2003 10:06 cc:
AM Subject: Re: Cut off dates for TCS
Please respond to
"Doug Webb"
Miriam,
It depends. If the code set is "Medical" (such as CPT codes) , the cut-off
is based on the Date of Service; for "Non-medical" codes (such as ZIP codes
and Provider Taxonomy), the cut-off is based on the Date of Transaction.
For claims crossing a transition date, confusion reigns. I would ensure
that the two different code sets were in different claims (codes that
appear in Subscriber level segments or below), or Transactions (codes that
appear in higher-level segments).
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
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----- Original Message -----
From: Miriam Paramore
To: WEDI SNIP Transactions Workgroup List
Sent: Monday, June 02, 2003 11:44 AM
Subject: Cut off dates for TCS
Have heard conflicting reports from lots of experts that I respect...
So...
Is use of the HIPAA code sets dependent on the date of service of the
claim, or the transmission date of the file? What happens when the file
contains a mix of dates of service and some of those claims use the HIPAA
codes and some do not?
Best Regards,
Miriam J. Paramore (Co-Founder and President of HAWK)
President & CEO
PCI: e-commerce for healthcare
9001 Shelbyville Road
iTRC Building
Louisville, KY 40222
502-429-8555
www.hipaasurvival.com
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