Thanks Mary: However, I am able to extract all the codes from the raw
835 file from Meditech. My problem is that the payer legacy codes are
more specific than the ANSI codes; therefore, as a fictitious example:
Aetna sends me an 835 with reason code 16 which means: Claim/service
lacks information which is needed for adjudication.
The paper EOB would provide me with specifics on what is truly needed.
I.E. Patient needs to provide Form XYZ, or patient needs to update
information, or clinical documentation necessary, etc.
This is what we have seen in trying to take our commercial remits live.
Since we have an extensive denial/underpay department already in place,
the 835s and lack of specificity has made it very difficult to move
forward... it is like we are actually loosing data in most
circumstances.
Kim Scaccia, System Admin
Recovery Reimbursement
Patient Business & Financial Services
Halifax Medical Center
386-226-4590 opt 1 ext 2018
________________________________
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Thompson, Mary
Sent: Monday, October 01, 2007 11:44 AM
To: [email protected]
Subject: RE: [Talk] Aetna 835 file
Loading the data into tables / SQL including the Claim Adjustment Reason
codes, RA remark codes and the Claim Status codes and then query out of
the tables to get the information regarding payment, denials, etc.. This
will enable you to manage your 835 data and work your denials far more
quickly then you ever did with paper RA's as well as trend these items.
There is a lot of data in the 835 file and the most important thing you
can do is load it all into something that you can then extract the
information from for posting payments, ra codes, trending, denial
management, etc.
The codes and the definitions can be gotten from the Washington
Publishing Company web site. I check it monthly for updates and keep
our system current.
www.wpc-edi.com/products/codelists
Best of luck!
Mary
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Scaccia, Kimberly
Sent: Monday, October 01, 2007 10:22 AM
To: [email protected]
Subject: RE: [Talk] Aetna 835 file
Kevin / Tom: I see you are having the same experience with the
commercial 835s that I am... The reason codes from the payer are more
specific than the ANSI Code... A Few Questions:
Are you live with the 835 commercial?
If so, how do you work around these reason code differences?
(Specifically for payers who will discontinue sending the hard copy
remits after ERA Go live)?
Do you have a denials / underpay department? If so, how did they deal
with the differences?
Also, Kevin: Where were you on the Meditech L List? I have been asking
these questions on the L for a long time (with no responses)
:-)
Kim Scaccia, System Admin
Recovery Reimbursement
Patient Business & Financial Services
Halifax Medical Center
386-226-4590 opt 1 ext 2018
________________________________
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Thomas McManus
Sent: Friday, September 28, 2007 3:35 PM
To: [email protected]
Subject: RE: [Talk] aetna 835 file
Hi,
I have experience with this. The paper copy and the electronic copy are
different. Claims are indexed on account number. Another big
difference is the Reason Codes. The paper copy uses a more specific
reason code the electronic uses the Ansi standard codes which can be
vague.
Tom McManus
Tuomey Healthcare System
Sumter, SC
803.774.8645
________________________________
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Sexton, Kevin
Sent: Friday, September 28, 2007 2:55 PM
To: [email protected]
Subject: [Talk] aetna 835 file
This isn't really a BWS question....
The Aetna 835 file I am loading into Meditech doesn't match the hard
copy they have been sending us. Has anyone else run into this.
I was expecting patients A-Z but those patients are scattered all over
various electronic files.
-Kevin
