Is it actually written somewhere that a payer can't reject a claim that meets all the requirements of the implementation guide but not adjudication edits they have pushed to the front-end? For example, some health plans provide eligibility files to clearinghouses that then reject claims up front if the patient is not eligible.
Marcallee Jackson 562-438-6613 -----Original Message----- From: [EMAIL PROTECTED] [mailto:john.lilleston@;verizon.com] Sent: Friday, November 15, 2002 8:04 AM To: WEDI SNIP Testing Subworkgroup List Subject: RE: Payer Edits Patrice, Type 7 is still payer-specific but is only those specific payers that are mentioned in the guides. I guess they are the ones who had a voice in the meetings where the standards were developed. Any other subset of the rules need to be edited once the transmission is let into the application. It is against the HIPAA guidelines to reject something that does follow the IG guidelines. However, they can deny the claim or whatever once it is in their application if it does not contain the data the application is expecting. Does that make sense? _______________________________________________ John Lilleston Technical Supervisor Verizon Information Technologies, Inc. Healthcare Solutions 813-979-3225 [EMAIL PROTECTED] http://www.VerizonIT.com/ _______________________________________________ --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-testing as: [email protected] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
