Workgroup for Electronic Data Interchange (WEDI)
Strategic eBill Information Network (SeBIN)

SeBIN eBill Issue Submission Form

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Date Submitted: 12/06/2007
Submitter Name:
Debbi Meisner
Submitter Contact Information (Phone/Email Address):

Entity/Organization Name:
*Submit if submitter represents an organization or company.
Emdeon Business Services
Issue:
Differentiation of the WC file from Group Health (GS-08)
Description of Issue:
Providers are going to want to send their WC bills in the same file with their group health claims when using an intermediary such as a clearinghouse. Software vendors will not want to separate WC bills and put them into separate files.
Since the WC Implementation Guides are now changed to be in line with the HIPAA requirements and not using any data elements deemed as ‘Not Used”, is there really a need to have a specific code to designate WC.
Business Impact:
Using a separate code value will require major system enhancements for the provider/software vendors.
Proposed Solution (if any):
Instruct providers in the IG to use the same IG value in the GS08 that HIPAA uses and recommend as an option for trading partners who want to differentiate that they use the current proposed WC. But this would need to be agreed upon prior to implementation.

WEDI SeBIN website Work Group Issue Resolution Log:

Assigned Work Group:
) / Technology/Implementation
Issue Tracking Number / T002
Tracking Number Assigned by: / SeBIN Issue Triage Management Group
Date Logged: / 12/05/07
Status(issue status maintained by):* / Agenda Item for Dec 7 2007 meeting
Reviewed By: ( Reviewer)
Review Date:
Discussion/History:(may include discussion, minutes, committee comments, etc)
Discussed during the January 17, 2008 conference call
Discussed and resolved during the X12 meeting in Seattle on 1/28 and 1/29 2007
Committee Final Proposed Resolution: (resolution to be presented for voting members and /or publication)
The TDI requirement is to use the “A1” version of the guides in GS08. However, by agreement among trading partners they could use other designators in the GS08, including the WC suffix to indicate the differences between the Workers’ Compensation and other guides.
The use of the 004010X098A1 or 004010X097A1 or 004010X096A1 designation in the GS08 is only appropriate as long as there are no data elements or code values being used that are not in the corresponding HIPAA guides, and the usage and definitions of the elements foes not deviate from the usage and definitions in the HIPAA guides.
Several people commented thatthey felt using the HIPAA designations for GS08 would be the only way providers would be able to create WC eBills without software vendor changes.
Even on a transaction set designated with the A1 suffix in GS08, the Workers’ Compensation eBills are identifiable because they contain WC in the SBR09 element