----- Original Message ----- From: William J. Kammerer <[EMAIL PROTECTED]> To: WEDi/SNIP ID & Routing <[EMAIL PROTECTED]> Sent: Sunday, May 05, 2002 11:57 AM Subject: Re: our section of the paper wrt. ProcessSpecification/Role/ServiceBinding/Service
> Dick: > > Unfortunately, in a message centric system like the HIPAA standard > transactions, there's really no "Business Process" evident at the > interchange or transaction set level.... > If a Business Process exists - apparent at the level of interchanges - > it's solely that of sending an interchange and expecting a TA1 or 997 in > acknowledgement. You can't really say an 835 is expected in response to > an 837... True, the business process does not exist at the interchange level, but it does exist at the transaction set level, and below the transaction set level, as in your '837' - '835' example, where a 'process rule' applies at the CLAIM level. Each claim which makes it into the adjudication system (i.e., is not covered by a TA1 for rejected interchange, or 997 for rejected functional group or transaction set) should appear on a subsequent '835' document at some point. It may show "paid amount zero" for reason "not a valid subscriber number" or some such other "big mistake" by the submitter, but once the claim gets past the payer's front door, the submitter may expect an '835' - based adjudication. Michael Mattias Tal Systems, Inc. Racine WI [EMAIL PROTECTED]
