RE: 837 Looping question

Wed, 17 Sep 2003 17:44:53 -0700

Title: Message
Tom,
 
My take on it is different, and I may be wrong, but it would seem that the HL04 would indicate whether or not this Subscriber has Dependents, but the Subscriber him/her self "could" be a Patient within the same grouping.   
 
I do not see anywhere in the guide that says the Subscriber needs to be repeated in the case where there are also Dependents. 
 
  Subcriber1(2000B,2010BA,2010BB)
        HL*3*2*22*1   < this "1" says this hierarchical level has a Dep.
        SBR*P*18*....    < the "18" is required because this Subscriber is the Patient.
         CLM (2300)          for this Claim.
            Services (2400)
            ......
   Patient 1(2000C,2010CA) .. Subscriber1 Dependent
       HL*4*3*23*0   < this Hierarchy points to the Subscriber1 as its parent.
        PAT*01*...     < Spouse of Subscriber1
        CLM
           Services
 
   Patient 2 (2000C,2010CA) .. Subscriber1 Dependent
       HL*5*3*23*0   < again, points to Subscriber1
       PAT*19*...     < Child of Subscriber1
       CLM
           Services
 
.Subscriber2.......

The example on the bottom of page 38 - 40 of the 837 X098 (Professional) does show the above construct gave me that impression as it depicts Subscriber #4 with both a Claim AND a Dependent with a Claim.  Please let me know if I am reading that wrong.   
 
I thought I was pretty comfortable with HL Parent/Child constructs in having done a number of 856s in Retail EDI.
 
Respectfully,
Mary Burkinshaw
Axiom Systems, Inc.
 
 
-----Original Message-----
From: Tom Drinkard [mailto:[EMAIL PROTECTED]
Sent: Wednesday, September 17, 2003 7:28 PM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 837 Looping question

Actually neither option is correct.  You cannot mix a subscriber's with a patient's claims, unless you repeat the subscriber loop.
Given this premise, then if you modify option one by copying line one between lines three and four you would have a valid transaction set.  The end result would be as follows:
 
OPTION1
1.  Subcriber1(2000B,2010BA,2010BB)
2.      Clm(2300)
3.        Service(2400)
3.5.Subcriber1(2000B,2010BA,2010BB)
4.    Patient 1(2000C,2010CA)
5.      Claim
6.        Service
7.        Service
8.    Patient 2
9.      Claim
10.        Service
11.    Claim
12.       Service
13.       Service
14.Subscriber2.......
 
Tom Drinkard
EDIT, Inc.
(678) 795-1251 (voice)
(775) 458-6117 (fax)
-----Original Message-----
From: Sulabh Gupta [mailto:[EMAIL PROTECTED]
Sent: Wednesday, September 17, 2003 6:45 PM
To: WEDI SNIP Transactions Workgroup List
Subject: 837 Looping question

For 837P, I have a question regarding mutiple claims for one patient. For example in a transaction, Subscriber1 has two dependents. Subscriber1 has one claim, one claim for dependent Patient1, two claims for dependent Patient2.
Which is a right approach - option1 or option2(Notice the difference at line 11). Or, am I thinking in a wrong track, as mutiple claim lines for one patient under same Provider in same transaction set will not occur(only mutiple service lines). Thanks in advance.
 
OPTION1
1.  Subcriber1(2000B,2010BA,2010BB)
2.      Clm(2300)
3.        Service(2400)
4.    Patient 1(2000C,2010CA)
5.      Claim
6.        Service
7.        Service
8.    Patient 2
9.      Claim
10.        Service
11.    Claim
12.       Service
13.       Service
14.Subscriber2.......
 
OPTION2
1.  Subcriber1
2.      Clm
3.        Service
4.    Patient 1
5.      Claim
6.        Service
7.        Service
8.    Patient 2
9.      Claim
10.        Service
11.  Patient 2
12.    Claim
13.       Service
14.       Service
15.Subscriber2.......
 
 
Regards,
Sulabh Gupta
[EMAIL PROTECTED]
 
 
 

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The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.

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