Chris,
Thanks. Go for it! As you may recall from one of my earliest messages to
this list, I strongly suggested that this effort needed a glossary so that
all of us can use terms that have the same semantic definition for all of
us.
Would you like to be the starter and keeper of this project glo
Chris:
I'm just a populist at heart!
But I'm also a little confused! If you (a provider) have a standard
claim transaction intended for a particular National plan ID, say
987654321, you would build a single 837 with the payer (or plan?)
indicated in the NM1 within the 2010BB loop. You would no
William,
Thanks for your ongoing concern for us "little people (providers)", but the
more I think about divorcing the payor/plan ID info in the transactions
from the receiverID info in the ISA, the more I like it... because it
embraces the models in use today in which there really is no relatio
Rachel,
I would be glad to begin working on a draft list of specific terms and
definitions for this project. Can we start with Ron's proposed interchange
sender/receiver definitions?
>>INTERCHANGE(ISA) SENDER: Entity responsible for preparing the
transaction sets (ST/SE) into functional group
Kepa,
Thank you for continuing to re-explain this with examples... the beauty of
this proposal is finally sinking in for me. Am I correct in assuming that
the practice we discussed earlier of having several primary payors (i.e.,
several PlanIDs) in a single 837 would not break this model? I s
Ronald,
Let me clarify something that may not have been properly expressed. One
of the problems we are facing today, and will face more acutely tomorrow
with the HIPAA PlanID, is how to identify the entry point for a plan ID.
The entry point may not be the payer, but a PPO instead. Or we ma
