We agree Jan,
If the PayTo Provider wants an electronic remit ... the remittance's media
is not based on how they submitted the claims ... 837 or paper.
Nor does the type of 'tools' used during the adjudication process impact
that remittance media decision.
It won't matter if we used a Clinical Auditing product for Professional
Claims (like those available from McKesson), or APCs for Outpatient, or
DRGs for Inpatient. So far (knock on wood) we have not found a
show-stopper, so they will end up on an 835 if that's what the PayTo wants.
Marsha
Verizon Information Technologies Inc.
Managed Care Division
Phoenix, AZ
HOME OF THE WORLD CHAMPION ARIZONA DIAMONDBACKS
Phone - 602.678.6042
Fax - 602.678.6331
E-mail - [EMAIL PROTECTED]
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Jan Root
<[EMAIL PROTECTED] To: [EMAIL PROTECTED]
> cc: "'[EMAIL PROTECTED]'"
<[EMAIL PROTECTED]>
Subject: Re: 835 and DRG Processing
06/10/02 09:23 AM
Discharge Fraction is in the Data Element Dictionary (Appendix E). As
far as I know, most health plans will be using the 835 to respond to DRG
claims... at least that is what I'm hearing.... others?
Jan Root
[EMAIL PROTECTED] wrote:
>
> On the 835, data element CLP11,
> CLP12 and CLP13 are required when
> adjudication considers the DRG.
> How are Health Plans planning to
> use the 835 and DRG processing?
> Also, can anyone provide
> information on CLP13 (industry:
> Discharge Fraction)? Where would
> we find this information?
>
>
>
>
>
>
> Kelly R.Davis
> Nationwide Health Plans
> HIPAA Project Coordinator
> [EMAIL PROTECTED]
