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Tom,
I did look into the 4050 Guide and you indeed are
correct, although I have never had issues with Translating that type of
construct as I key in on the HL flags. But that is for Inbound Maps,
so they will work either way. My biggest concern here is the Outbound maps I
have built. I may have
to restructure them although Claims for both Subscriber and Patient are not
common, it is those situations that will make trouble somewhere down the line...
they are the ones I look for in testing my maps.
It is
a shame that those of us 'techies' in the trenches building the Maps and
Translators do not have time to be more involved in the workgroups.
I would give my eye-teeth for that kind of time. (Keeping up with
the often important and informative information on this Listserve is too a
challenge. I am sure I am not alone in that one).
The IG
that was adopted for HIPAA and the one I have been Mapping from I have read many
times over and used as Bible.. particularly the examples. I guess
with the future in mind, I should refer to the 4050 Guide also *sigh*, although
the fact that it is "Draft" made me leary of doing so. It is
difficult enough interpolating the 4010 with the Addenda, ...which I refuse to
kill trees for and print.
I do
appreciate your clearing this up for me... although I am struggling with the
fact that 4010 is the adopted version, yet we are to be using a draft
version as a HIPAA guide?
Respectfully,
Mary Burkinshaw
Axiom
Systems, Inc.
-----Original Message-----
From:
Tom Drinkard [mailto:[EMAIL PROTECTED]
Sent:
Wednesday, September 17, 2003 8:56 PM
To: 'Mary Burkinshaw'; 'WEDI
SNIP Transactions Workgroup List'
Subject: RE: 837 Looping
question
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)
(678) 795-1251 (voice)
(775) 458-6117 (fax)
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
.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.
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)
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.......
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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
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