I am forwarding this for comments. Thanks for your help. Thanks. >>> <[EMAIL PROTECTED]> 06/26/02 02:21PM >>> Question about how you setup to do level 7, partner specific edits, versus the generic levels 3-6. I am having trouble distinguishing between TPA negotiable fields that also happen to be situational fields (per IG) and/or code set fields (per IG) and/or product or service-specific fields. For example, Long-term care claim (837I). Discharge hour (2300 DTP03) is optional per IG, but becomes required if the third byte of the Bill Type value (2300 CLM05-03) is equal to "4" (equates to "last bill"). The IG doesn't explicitly define this situation, you have to refer to the National Uniform Billing Data Element Specification (not within IG) to find the values or know the UB92 very well. Questions:
1) How do you capture this "situation" test within your testing rules engine if it's not documented in the IG? 2) How many other "gotchas" like this one within the IGs? How do you unearth them? 3) Is it a level 4 test or level 6 (product type) test? If CLM05-03 = "4" (or "last bill"), DTP03 should be valued. Is this a situational test? 4) Because LTC claims are all billed as interim status, it shouldn't have a discharge hour. Therefore, CLM05-03 should be valued with an "interim bill" value (e.g., "2", "3") and never a value of "4". Does checking the value of CLM05-03 become a situational test or product type test? Thanks, Joe Yelanich Direct: 480-563-5799 To be removed from this listserv, please email [EMAIL PROTECTED] <P>The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
