Kepa, To my way of thinking, a "transaction" is everything within an ST-SE pair. Thus, even if there were 10,000 claims contained therein, it would still be one "transaction."
-----Original Message----- From: Kepa Zubeldia [mailto:[EMAIL PROTECTED]] Sent: Friday, July 19, 2002 8:01 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: When is a claim a standard claim? Rachel, Thank you. Exactly what we needed to start this debate going. I knew you would pick up on my "singular" vs. "plural" comment, especially since I made it up, to stir up the debate. But the question is still the same. When the Secretary adopts a standard for claims, is the standard for the equivalent of a UB92 or HCFA-1500, or is the standard for a container that can hold 5,000 of those critters? Two possibilities: A) If the standard is for the container, the presence of even one individual claim inside the standard container will taint the whole thing and the entire container, regardless of how many good claims it has in it, becomes a non-standard EDI transaction and must be rejected as a unit. B) If the standard is for the equivalent of a single UB92 or HCFA-1500, which must be individually shaped to fit the X12 container, then each one must be rejectable or acceptable independent of each other. We currently don't have a standard way to do these "claim" acceptance or rejections, but that should not get in the way of progress. So, is the standard for the egg or for the carton of eggs? Is a "transaction" a single claim, or an "EDI Transaction" with many claims in it? As usual, I have my opinion, but I want to hear a lot of other opinions first. Kepa Zubeldia Claredi ------------------------------------------------------- On Friday 19 July 2002 06:05 pm, Rachel Foerster wrote: Kepa, I understand your arguments. However, the language of the original statue does clarify a bit, I think. Here it is: ��(7) STANDARD.�The term �standard�, when used with reference to a data element of health information or a transaction referred to in section 1173(a)(1), means any such data element or transaction that meets each of the standards and implementation specifications adopted or established by the Secretary with respect to the data element or transaction under sections 1172 through 1174. Key words are that the standard is any data element or transaction..... Now, if you look at the actual language of the Electronic Transaction Final Rule, you see: Subpart K�Health Care Claims or Equivalent Encounter Information � 162.1101 Health care claims or equivalent encounter information transaction. � 162.1102 Standards for health care claims or equivalent encounter information. (b) Dental Health Care Claims. The ASC X12N 837�Health Care Claim: (c) Professional Health Care Claims. The ASC X12N 837�Health Care Claim: (d) Institutional Health Care Claims. The ASC X12N 837�Health Care Claim: Note in each instance the use of the plural "claims" and not the singular "claim".....thus I believe I could make as equally a persuasive argument that an 837 Transaction containing multiple claims, of which only one claim is not in compliance, that the entire transaction is not in compliance since the original statute specifically declares that the "standard" is either the transaction, or the data element. Rachel Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 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/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. 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/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
