Will encounters from the same billing provider be grouped together?


Answer:

When the plan submits their ANSI ASC X12 837 Health Care Claims (837) to Palmetto GBA it must conform to the standards as outlined in the Technical Report - Type 3 (TR3). This standard employs a hierarchical data structure, which allows for relating many encounters to one billing provider. The Billing Provider Hierarchical Level is a required segment and is identified in the 2000A Loop of the 837. The grouping of encounters to the billing provider will be done by the MMPs.


Last Updated: 04/15/2014