Raj, "Submitter" (in Loop 1000 of the 837) seems to refer to the entity who did the original packaging of the transaction (within the first interchange that it traveled in)... generally either the provider or the provider's business associate. The "Receiver" in loop 1000 would be the original destination target for the claim... generally either the payor or the payor's designated business associate. Based on my reading of the front matter on the Loop 1000, these submitter/receiver designations remain fixed for the life of the transaction. A repricing function would not seem to change the identities of the original submitter/receiver. An alternative use of loop 1000 as an audit trail of all parties who "opened" the transaction is mentioned, but the IG advises against using Loop 1000 in this way.
Based on my reading of the IG, I would say that a "repricer" would leave loop 1000 information on the repriced claim exactly the same as when he received it. What is not clear to me, however, is the intended business use of loop 1000. EDI addressing for the interchange will always be accomplished with the ISA sender/receiver fields. So is the loop 1000 "submitter" ID supposed to contain an EDI address for "answering" messages like requests for additional information, error messages, possibly even claim payments? If so, then every transaction capable of triggering an "answering" message should have one of these and its usage in the IG should be explained a little better. Am I interpreting the IG correctly? Regards, Chris At 06:22 PM 2/22/02 -0500, Thuppanna, Raj wrote: >I have a question about submitter/receiver in a re-pricing model. In this >example, we receive the claim for re-pricing. We are not destination payer. > >According to 837 IG in the scenario where a provider (or providers billing >service) sends the electronic claim to us for re-pricing, the provider is >the submitter and we are receiver. We then re-price the claim and forward it >to destination payer. Who should be the submitter and receiver when we >forward the claim to payer? My understanding based on IG is that submitter >and receiver should remain same when we forward the claim to destination >payer. But It doesn't make sense for us to be receiver here. > >In the same model, it we get a paper claim from a provider and then forward >the re-priced claim, who should be submitter and receiver? My understanding >is that we are the submitter and destination payer is the receiver. > >Any help is appreciated > >Thanks > > >Raj Thuppanna >770 444 4468 > > > > >********************************************************************** >To be removed from this list, send a message to: [EMAIL PROTECTED] >Please note that it may take up to 72 hours to process your request. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
