Peter, I thought I understood the DDE rules, but this language conflicts horribly with our present discussions in vision. "Richer data content" on the DDE claim systems seems to be the most common practice in our industry. Frankly, it's no help to me (provider) if the payor rewrites the html code so that the non-standard data is on separate screens... I still have to hand-type it in for 80% of my claims to get paid. The larger vision payors simply declare this to be "attachment" data for which a standard has yet to be created. How does this (apparently giant) attachment loophole reconcile with:
" A health plan may not add additional information to any of the standard transactions. It may, however, provide additional information through a separate mechanism....The resolution of the standard transaction cannot depend on the additional information"?? I think we will need some clarification from HHS. I could understand a payor requiring "additional information" on 1 or 2% of the claims... even 5 or 10%... but when they require it on 80% it smells to me like a proprietary claim format... end of story. Thanks for all your work on this tricky "exception", Peter. -Chris At 09:51 PM 1/13/02 -0500, [EMAIL PROTECTED] wrote: >Dear Joan: > >I believe that your interpretation is correct. The keys are separation of >the optional data from standard and that the optional data is in fact totally >optional, not only that processing the transaction must not be dependent upon >it, but through the no-incentive rule incentive for inclusion of optional >data is not permitted. In the Impact on DDE paper we addressed this issue in >paragraph 8.12, which I have copied below. > >Peter Barry > >8.12 Richer data content. Some existing screens may contain data entry >and data response fields that are not in the standard. Continued inclusion >of such fields would be non-standard except on a separate screen or, >presumably, a section of the screen that is clearly separate from the >standard. The key rule is that neither a payer or provider is permitted to >require data in addition to the standard. The HHS response was: > > "A health plan may not add additional information to any of the standard >transactions. It may, however, provide additional information through a >separate mechanism. For example, the web-based service described in the >question could provide additional information on a web page separate from the >web page containing the standard data content. The resolution of the standard >transaction cannot depend on the additional information.[c.f. Attachment Q4 >at end of this paper]" > >---------------------- >In a message dated 1/10/2002 6:11:16 PM Central Standard Time, >[EMAIL PROTECTED] writes: > > > Subj: DDE and the Use of Utilization Review Protocols for 278 Transacti > > ons > > Date: 1/10/2002 6:11:16 PM Central Standard Time > > From: [EMAIL PROTECTED] (Boyle, Joan) > > To: [EMAIL PROTECTED] (SNIP Business Issues Listserv (E-mail)) > > CC: [EMAIL PROTECTED], [EMAIL PROTECTED] (Gratias, Greg) > > > > Has there been any discussion of the use of utilization review protocols > > (such as those from M&R or InterQual) in interactive DDE applications for > > the 278? Display of these protocols in separate windows that would pop-up > > in response to input by the provider could enhance the accuracy and > > usability of the data that the provider ultimately submits on the > completed > > 278 transaction. If these pop-ups are clearly separate from the >transaction > > form and their use is optional, the payer presenting the "extra" questions > > would not be actually requiring additional data for completion of the > form. > > The submitted transaction would include only the data content of the 278. > > > > Any thoughts? > > > > Joan > > Joan Boyle > > HIPAA Compliance Manager > > The TriZetto Group, Inc. > > Direct: 970-627-1675 > > Fax: 970-627-1677 > > [EMAIL PROTECTED] > > > >********************************************************************** >To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?list=business >and enter your email address. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address.
