Change Request Detail
No.
1027
Date
7/22/2005
Submitter
Type of Request
Pertaining to more than one, or not sure
Status
DSMO Process Completed
Business Reason
Payer entering arrangement with Financial custodian for HDHP (HSA). Financial custodian will issue credit card. Member will use credit card at point of service. Agreement is for payer to send claims liability and cost share data to the Financial custodian, who will then match to their credit card authorization file, and if matched, provide settlement to the merchant (provider).  Match process can result in full match, no match or soft match.  Potential for better match processing and better experience if we can identify a mechanism for provider to enter the credit card autghorization number and "swipe" date on the 837's.  Currently no field available to provide these data elements.  More background available on request.
Suggestion
1) Create a new qualifier for the PWK segment and allow the info to be entered in PWK area?
2) Create new claim level Ref segment for credit card authorization number and swipe date? 
3) Consider allowing segments like credit/debit Billing information to be available for submission to payer at claim level? 
4) Add another loop and qualifier to Prior Authorization number ?
5) Add a NTE segment to Institutional and Professional?


Note...I'm specifiying 837I and 837P...could have ripple effect on 277 and/ or 835 to display the data?    Possible impact for 837D and NCPDP for their HSA/HRA processing?
DSMO Category
B
Recommendation
Approved.  The DSMO agrees that additional functionality with respect to HSAs is necessary.  The business processes need to be more fully understood. The requestor lists several alternatives.  The DSMO recommends that the submitter, with other business principals, and appropriate SDOs, and WEDI, evaluate the options and develop a suitable solution for the standards.
Appeal Recommendation