Chris Rachel is correct. If a provider wants to perform any or all of the electronic transactions covered by HIPAA it must be in the standard or they must use a Clearinghouse to translate the transactions to be transmitted to the plan(s). Providers cannot create groups to thwart the regulation.
Dave Lounsberry Electronic Commerce Blue Cross Blue Shield of Nebraska [EMAIL PROTECTED] 402-548-4423 ------------------( Forwarded letter 1 follows )--------------------- Date: Tue, 22 Jan 2002 12:53:49 -0600 To: [EMAIL PROTECTED] From: Rachel.Foerster[rachelf]@ix.netcom.com Sender: [EMAIL PROTECTED] Reply-To: [EMAIL PROTECTED] Subject: RE: Plan requirements Chris, I disagree with your conclusion about a closed group of providers conducting proprietary transactions with a health plan as being "legal" under HIPAA. Once the providers choose to conduct any transaction specified by the final rule, they become a "covered entity" and must do so in compliance with the specifications. Health plans must conduct the transactions in compliance with the specifications. If the providers and health plan choose to ignore this requirement, both are then in violation of the law and the rule and are subject to penalty. My personal opinion is that a health plan must be able to conduct the standard transactions by the compliance date regardless of whether a provider is requesting they do so or not. In order words, the health plan must be able to conduct the standard transactions by the appropriate compliance date: 10/16/2002 if they choose not to request an extension, or 10/16/2003 if they opt to request an extension and file the required plan. Rachel Foerster -----Original Message----- From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]] Sent: Tuesday, January 22, 2002 12:44 PM To: McCall, Allen; '[EMAIL PROTECTED]' Subject: Re: Plan requirements Plans are required to have the ability to respond with a standard transaction... to a provider's request for a standard. I have actually wondered myself what would happen if a relatively "closed" group of specialized providers WANTED to exchange only non-standard electronic transactions with a payor who never communicated with any other providers... and also wanted this proprietary exchange. This would be a very unlikely scenario, but I think it would be technically legal. -Chris At 10:26 AM 1/22/02 -0800, McCall, Allen wrote: >Is a health plan required to have the capability to send/receive standard >transactions even if none of the providers they work with want to conduct >the transactions electronically? > >The Response on page 50314 indicates that they must but in the rule >162.925 it indicates that they must only if the providers request it. > >Allen McCall >Sierra Systems >711 Capitol Way SE, Suite 304 >Olympia, WA 98501 >Telephone: (360) 357-5668 >Mobile: (425) 894-0790 >Fax: (360) 754-0480 >[EMAIL PROTECTED] ><http://www.sierrasystems.com>http://www.sierrasystems.com > >********************************************************************** >To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?listsiness >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. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list =business and enter your email address. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address.
