There really is no such thing as a 'closed' health plan. It is somewhat routine that members of a health plan go out of their service network to get service for example when they travel. Regards, Dave Frenkel ----- Original Message ----- From: Rachel Foerster <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Tuesday, January 22, 2002 10:53 AM 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.
