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Right now, the communication between provider/payer through HCX is a four leg process - e.g. in case of preauthorization - If there is a need to send Acknowledgement communication to the provider for any pre-auth request or claim request, then an HCXPreAuthResponse object with minimal claimresponse may be used but then it will be a minimum six-leg process for each pre-auth request and increase traffic across HCX gateways. |
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@angshu I think you are referring to EDI 277 Healthcare claim status notification response where EDI 277 A is used by payer to notify the claim response to a provider which is unsolicited response but EDI 276 which is claim status inquiry can be solicited by provider to seek the status inquiry on preauth or claim submitted by it to payer. |
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Dear All,
In our analysis process and effort towards documenting the standards, the scenario of acknowledgement has come up.
When a pre-auth (or a claim) is registered, a case number/id is generated at payor's end. Subsequently all communications use this case-id, which is sent over to the provider. The question is what is the appropriate means (using HCX protocols) of communication such case-id through acknowledgments.
HCX Protocols support both means. Would request feedback from the group on deciding what would be the most appropriate way. Please pour in your thoughts.
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