Hi,
The question is:
>>When a claim transaction contains a subscriber loop with BOTH Subscriber and
>>Patient level claims, should the SBR02 value be equal to "18" (subscriber is
>>the patient) or empty (subscriber is not the patient)?
For example:
The 837P claim may look like this
HL*22*...
SBR*..*18
CLM...The claim for Subscriber
HL*23*....
CLM*..... The claim for Dependent...
While populating SBR02 we can have 2 possible cases
1. Subscriber is Patient:
2. Subscriber is not Patient:
In the above question
1. Subscriber is Patient = True
2. Subscriber is not Patient = False
Hence SBR02 = 18.
The SBR02 Rule condition does not state that, when SBR02 = 18 then
ONLY SUBSCRIBER CAN BE PATIENT AND DEPENDENTS CANNOT BE PATIENTS.
==================
Next case
HL*22*...
SBR*..*18
CLM...The claim for subscriber
CLM*..... The claim for dependent1 This in Incorrect.
CLM*..... The claim for dependent2 This in Incorrect.
HL*23*....
CLM*..... The claim for dependent...
All Dependent claims have to have a 2310CA loop to identify the Dependent and the relationship between Subscriber and Dependent.
Here since the subscriber is also the patient SBR02 = 18
I hope this helps.
Ganesh Bhat
-----Original Message-----
From: Martin Scholl [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, June 19, 2002 06:13 PM
To: Deepan Vashi; Karen Phelan; [EMAIL PROTECTED]
Subject: Re: SBR02 Question
I agree with Deepan.
You should have the subscriber (HL***22) hierarchical level twice, Once for claims where the patient is the subscriber, and then again when the patient is a dependent of the subscriber. Otherwise you create contradictions or ambiguities.
Martin Scholl
Scholl Consulting Group, Inc.
301-924-5537 Tel
301-570-0139 Fax
[EMAIL PROTECTED]
www.SchollConsulting.com
----- Original Message -----
From: Deepan Vashi
To: Karen Phelan ; [EMAIL PROTECTED]
Sent: Wednesday, June 19, 2002 4:51 AM
Subject: Re: SBR02 Question
Karen,
How about using the following to solve the problem....do reply back.
ST
Subscriber HL
SBR use 18
Subscriber level Claim information
Subscriber HL
SBR do not use 18
Patient HL
Patient level Claim information
SE
Regards
Deepan
----- Original Message -----
From: "Karen Phelan" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, June 19, 2002 4:49 AM
Subject: SBR02 Question
> Here is a question for the HIPAA "interpretation team".
>
> When a claim transaction contains a subscriber loop with BOTH subscriber and
> patient level claims, should the SBR02 value be equal to "18" (subscriber is
> the patient) or empty (subscriber is not the patient)?
>
> Any advice you can provide would be appreciated.
>
> Karen Phelan
>
>
