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interpretation of situational stuff!
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Hi all,
How do I interpret some of the situational stuff
within the IG?!
Example on the 837P(Pg.178), CLM11-5 says...
"Required if the automobile accident occured out of
the US to identify the country in which the accident
occurred."
Now for instance, there is a claim that I receive from
the provider on which CLM11-5 is blank though it is an
accident claim occured out of US.
Do I care to code this as a rule within my(payer)
system?! If yes, How do I identify this as a rule to
be coded within my system(Payer side) to reject the
claim?! There are ample amount of such situations
within the IG and I am wondering if it is left to the
providers' discretion to populate this element?!
Regards
Damera.
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