d maintenance? For the payers, maintaining their own CPP entry is just plain smart
business - if you assume processing claims
electronically is less expensive than processing paper claims.
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
- Original Message -
From: "Martin S
hose values on the 835 Remittance or the 277 Claim Status (loop 2220, segment REF,
qualifier 'FJ' line item control number;
similar mandate to return the value supplied on the 276), that seems plenty good
enough to me.
(I think this belongs on transactions listserve, but I'm no
is checked using the patient's HIC #. This file contains the secondary
payer info for the patient/insured. (For Medicare, patient always = insured,
unless Congress got into the act recently.).
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
discussions on this listserv therefo
So please, I'd appreciate some
> succinct words of explanation that one could use when talking to industry
> participants about how identifiers, addresses and delivery channels,
> elements of the Healthcare Collaboration-Protocol Profile (CPP), discovery
> of Healthcare CPPs via a Registry help a
ut if you wish to further process this document from the sending
party as identified within the transaction set. However, you should be able to
do this kind of mapping without regard to the applications identifiers based
solely on the version/release in the GS segment.
In an ideal world (give me a
ittance Advice. (Or, I guess, not getting paid at all, but that does not
sound terribly inviting).
Last time I checked (maybe two months ago?), Medicare Part "B" providers could
still get paper remittance advice, but I'll betcha that is temporary at best.
Michael Mattias
Tal S
SI 004010, ISA receiver qual/id= whatever, Sterling VAN, no SDQ, Limit
100 Line items, ItemQual = VN
If I have their catalog (or got the Vendor part number from their web site or a
service like QRS,) I can give him the part number he wants. CONCEDED... credit
is a problem. But suppose I specify t
) in RECEIVER section needs
> to be "generic" and moved to DOCUMENT section (line items type).
>
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
roduct to process the 835; but
about the only thing Sally Provider would need to know about a payer's
remittance capability is, "ANSI Remittance Available Yes or No?".
(Unless, of course, Sally is going to set up Ole Doc Smith's office in the
registry to help all those payers
ed
Claim Status (edit report), ASC X12N 003070X070 (possibly to be replaced by
004020X030)" was not yet available at the WPC site,and the HCFA/CMS regulations
had not yes defined this as a 'covered transaction.'
Did I miss something?
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
ear 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]
means they are 'processed' (or in your language, "adjudicated"), which
IMNSHO is all the submitter can ask.
Any claim so denied should appear in the next '835' remittance sent to the
submitter with the appropriate adjustment code(s).
Michael Mattias
ns, or do we just post 'em here and
hope for the best? ( Moderator help?)
(Note: I sent this to a communications expert with whom I may work and he may
comment as well).
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
real time processing environment and vice versa."
(As you can tell, the spec writers apparently did not grasp that 'add[ing] an
extra letter' is the same as 'using different identifiers').
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
www.talsystems.com
Payer, Ms. Provider, your EDI address is a service bureau? Fine, as long as
it's transparent to me and your other partners.
BIAS ALERT: I expect service bureaus and clearinghouses will be my competition,
so I am not likely sympathetic to any "special needs" claimed by these entities.
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
www.talsystems.com
7;batch
eligibility check' department.
For eligibility a provider must be able to query the payer for batch vs.
realtime capability anyway, so why not get the appropriate 'department address'
when querying a potential receiver (payer) for capabilities?
Also, this VASTLY simplies any registry: an entity has but one EDI address to
maintain. (This also makeslife easier on VANs).
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
Thursday 4/4 or Friday 4/5 as I will
be taking another trip though boring scenery until then.
Thanks,
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
nce changed, but you can get there from the suggested ebXML 'home' page
easily enough) and now I have a little reading to do ...
(Although IE 5.0 won't read that ebXML, I have a couple of XML parsers here and
if one of them don't work 'as is' I can modify one to ma
who used identifiers for other than the original intent? Tough. As the
Pennzoil man says, "pay me now or pay me later." It is now later.
Michael Mattias
Tal Systems, Inc.
Racine WI
[EMAIL PROTECTED]
ED EARLIER ===
Also, it was pointed out that the ID you saw, "PPPS_INFO" is not exactly
user-friendly. Well, I never supplied that information on the "join" - PPPS_INFO
is the "user friendly" (to my mail administrator) identifier of a mail account
on my
domain/web
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