Change Request Detail
No.
1071
Date
9/28/2008
Submitter
Type of Request
Payment of a Health Care Claim
Status
DSMO Process Completed
Business Reason
We need a compliant way of adjudicating claims for transplant living donor claims. 

From a provider perspective they would submit the 837 claim correctly reflecting the donor as the patient (Loop 2000C, PAT01=39). 

However, there is no corresponding Loop/Segment of this patient relationship in the 835 claim payment.
Suggestion
Add the same Loop/Segment to identify the organ donor on an 835.
DSMO Category
D
Recommendation
Disapprove.  The DSMO noted that insufficient information was provided to support a business case for the change. Research was conducted with large hospital organizations that perform many transplants, who indicated that this information is not needed. Therefore there is no need to report this information back in the 835.
Appeal Recommendation