In spite of the examples being somewhat problematic, the question, as I understand it is: "Can I submit multiple claims for the same patient (or subscriber) without having to repeat the patient (or subscriber) loop for each of the claims?" And the answer is "yes".
For instance, if each claim represents an individual patient encounter, and you do billing once per month, and you have seen the same patient several times that month, you would submit one patient (or subscriber) loop followed by several 2300/CLM loops for that patient. If some validator cannot handle multiple claims per patient (or subscriber) then they need to fix that validator. This is clearly described in the implementation guide and is part of the intended use of the 837. I hope this helps you. Kepa Zubeldia Claredi PS: Note, I am NOT discussing the submission of claims for both the subscriber and patient in the same subscriber loop. That problem was addressed by Tom's comments below. On Wednesday 17 September 2003 06:55 pm, Tom Drinkard wrote: > Mary, > The bottom line in this discussion is SBR02. > Either it has a value of 18 (Self) or it must not be used. > The actual note in the Professional Claim guide says: > "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." > You can't have it both ways. Therefore, you must repeat the 2000B loop > in order to have claims for the subscriber and one or more patients. > > This topic has been discussed at length in the Health Care Claims > workgroup at X12N. Please see the draft copies of the 4050 guides for a > clearer presentation of the intent of the workgroup. > > Tom Drinkard > EDIT, Inc. > Co-Chair X12N/TG2/WG2 (Health Care Claims) > [EMAIL PROTECTED] > (678) 795-1251 (voice) > (775) 458-6117 (fax) > > -----Original Message----- > From: Mary Burkinshaw [mailto:[EMAIL PROTECTED] > Sent: Wednesday, September 17, 2003 8:34 PM > To: WEDI SNIP Transactions Workgroup List > Subject: RE: 837 Looping question > > > 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. > [EMAIL PROTECTED] > (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] --- 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. 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