>>> "Thaler, Patrice M" <[EMAIL PROTECTED]>
10/10/01 11:09AM >>>
I agree with Don. As a provider I do not want
to have to access DDE
systems. I want the full benefits of REAL EDI
(computer-to-computer)
using the 270 and the 271.
If the health
plan does not provide me with the same data in the
response of a 271 that
it provides in DDE or a web page - then I feel it
would violate the intent
of HIPAA (to reduce administrative costs).
When a 271 does not come
back with a health plan's full range of
benefits then my registration staff
will have to pick up the phone and
call the health plan (more $$$) and/or
perform a DDE function or web
page lookup (which will also mean more $$$).
The costs increase because
this requires another step, it takes time for
the registration clerk to
perform this manual function, and it means the
clerk has to key the data
into our hospital application which means the
clerk might make keying
errors, which means the claim could be denied
(perhaps we entered the
member number incorrectly) thus administrative
costs go up.
Patrice Thaler
Allina Health System HIPAA
Project
-----Original Message-----
From:
[EMAIL PROTECTED] [
mailto:[EMAIL PROTECTED]]Sent:
Wednesday, October 10, 2001 10:57 AM
To: [EMAIL PROTECTED]
Cc:
[EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: RE: White Paper - Impact
on DDE Services
Stanley,
The question regarding
"additional information" came up at our last X12N
meeting in the
Eligibility Work Group. I'm not sure I fully agree with
your
answer. It seems to me, that if additional information is
provided
on
the transaction that would be of value to the provider, then
it should
also
be on the 271 transaction or else it makes the DDE
solution more
desirable
to use than the 270/271, which is not permitted
by Final Rules for
Transactions Section 162.925(a)(1-4).
If the 271
transaction can't support the information, then I would
suggest
that
this addtional information should be set up as a distinct inquire,
separate
from the eligibility inquiry. If the 271 has a short coming
in
providing necessary information, then the health plan should bring
this
to
the attention of the X12N SDO via the DSMO process or they
should attend
the X12N conference and Eligibility Work Group and raise the
concern
there.
Don Bechtel
"Stanley
Nachimson" <[EMAIL PROTECTED]> on 10/09/2001 10:45:52
AM
To: <[EMAIL PROTECTED]>,
<[EMAIL PROTECTED]>
cc:
Subject: RE: White Paper - Impact on
DDE Services
There are two questions being discussed here.
Regarding the "additional
information" we have considered that any DDE
system can provide
additional
information on additional screens (or
using links if it is a Web based
system). However, providers can not
be required to access or accept the
additional
information.
Regarding the need to accept a 270 and respond to a 271,
that is a
requirement of the regulation. A web based DDE system can
be offerred
as
an option, but requirment is that the regular EDI 270/271
EDI
transaction
must be supported.
Stanley Nachimson
Office of
Information Services, CMS
410-786-6153
>>> "Neumeister,
Tammy" <[EMAIL PROTECTED]> 10/09/01 09:40AM >>>
This
question has raised another question at our organization. We
are
considering purchasing a product from our payor software vendor
that
would
allow web access to providers for eligibility inquiry,
referrals, and
claim
status inquiries. Is this sufficient to
comply with the HIPAA
requirements
for electronic capabilities for these
transactions or must we also be
able
to accept and return an EDI 'batch'
transaction for providers?
Tammy Neumeister
SAS
Programmer
MercyCare Insurance Company
PO Box 2770
Janesville,
WI 53547-2770
800-752-3431 X 3068
Direct 608-758-7725
Fax
608-752-3751
[EMAIL PROTECTED]
> -----Original
Message-----
> From: Karen LaJaunie
[SMTP:[EMAIL PROTECTED]]
> Sent: Monday, October 08,
2001 3:44 PM
> To: [EMAIL PROTECTED]
>
Subject: White Paper - Impact on DDE
Services
>
> I have a question regarding the 'Impact on DDE
Services' White Paper -
> 8.15 No Incentives for Using
DDE.
>
> Is it considered an 'incentive' if more information is
returned via a
Web
> Site transaction than from an EDI
Transaction?
>
> For example, if a provider inquires about a
Member's Eligibility via
our
> Web Site, our Web Site has the ability
to return more information
> regarding the eligibility of the member
than our EDI process which is
> controlled by a vendor
system. Is this considered 'incentive' for
the
> provider
to use our Web Site rather than submitting the 270 via EDI?
>
>
Any input regarding this issue is appreciated.
>
>
Thanks!
>
>
>
> Karen L. LaJaunie
> Senior
Project Consultant
> Blue Cross Blue Shield of Kansas City
>
Phone: (816) 395-2635
> Fax: (816)
395-2605
>
>
>
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