sriniemr wrote on Monday, June 11, 2012:
Could you pls anyone explain, what is meant by x12 encounter claim?
What is the difference between normal x12 and encounter based x12 file
thanks
kevmccor wrote on Wednesday, June 13, 2012:
An “x12 encounter claim” probably refers to a claim filed electronically in an x12 format batch file. “x12” refers to a so-called standard for insurance claims, insurance eligibility inquiries, claim status, and claim payment information transmitted over the internet in files named 837, 999, 835, 276, 277, 270, 271, etc. (now in 5010 format, which replaced the 4010 format). There are specific requirements for each type of file and the OpenEMR “batch” file is the 837 type, with one or more claims contained in the file. The x12 standard is kept as mysterious as possible while still being usable, just as the ancient guilds would not divulge their methods (so what’s new?). There are many different x12 file types for different types of transactions, not just health care. Many are not based on an “encounter” type concept as is used in health care - everything relates to a specific patient encounter. Inventory or shipping type transactions may be an example. An “encounter based x12 file” means you just want to think of health care x12 files that way.
All the above is just IMHO.
tmccormi wrote on Wednesday, June 13, 2012:
Funny…
The Encounter X12 is a claim that is used for reporting ONLY. Some Medicare carriers require you to submit 1 claim for getting paid and 1 claim for reporting (Wellcare, for instance). The only difference is in the BHT record the claims is type ‘RP’ (reporting) instead of ‘CH’ chargeable.
-Tony
kevmccor wrote on Wednesday, June 13, 2012:
Thanks, Tony. Another nuance of the secret standard revealed.
weesnerkim wrote on Friday, June 29, 2012:
Now if we just had a way to clear all the encounter claims out of the system when the the HMO sends the check for the month. Doing it claim by claim takes way to much time.
Kim Weesner
A.D.O.C., Orange County, CA