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Back  RFI # 622: 837P Encounters vs. FFS

Formal vs. Informal Help Informal Formal

Submitter

Kenneth Greenspan

Description

This is not really an interpretation question, but I was wondering whether an encounter using the 837p requires substantially less data than a billable claim 837p, or if much of the data could be in essense hard-coded because it’s non-billable. I'm planning to do some research based on utilization but I was wondering if anyone knew offhand whether encounters require less elements than FFS claims.

Thx,
Ken

Submitter Assigned Keywords

Encounters

Response

Usage requirements and situational rules as stated in the Implementation Guide apply to both claims and encounters, except for those specific situations where language in the guide indicates otherwise.

Recommendation

For an encounter process covered by the regulations, review the situational requirements to determine if they apply to the encounter process you are implementing. For example, situational requirements that state a requirement when a segment or element "is known to impact the adjudication of the claim." would not apply to encounter data sent only for research.
Submission 1/23/2008
Status Date 4/3/2008
Status F - Final
Primary References
Document 004010X098A1
SectionHeader
Page64
Set ID010
Segment Position010
Segment IDBHT
Element Position06
Industry NameTransaction Type Code
Code ValueRP