The ability to report insurance-specified identifiers for
the performing hospital facility/service is a requirement
of many carriers who routinely forward claims to secondary
payors for Coordination of Benefit billing (COB). Prior to
the HIPAA formats, a default secondary payor identifier was
reported in the batch header records for Medicare,
Medicaid, Champus, and up to two 'Other' groups, and the
appropriate specific identifier for a given patient was
reported in the same record that identified that patient as
having the secondary coverage. With the new format mandated
by HIPAA, the ability to report a patient-specific
exception to the generic provider identifier previously
reported in the batch header has been eliminated, requiring
the ability to group patients and report the correct
identifier for each provider group in the batch header
record. There is a limit in the specifications of 5000
batches per claim file, so the grouping of like patients
together is a requirement, particularly for hospitals with
larger patient volumes. In order to accomplish this, the
present design would require seperate claims for almost
every combination of insurances possible on a patient
(several million unique claim entries in all).