Would your response also apply to this situation: A government program that provides mental health care contracts with local agencies (also government) to provide the services. The government program is required to report the lawmakers its performance and to track services. The program currently collects data from the local agencies that is not included in a 837 encounter in order to meet its reporting requirements.
Can it continue to collect the data in non-standard transactions? Allen -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Tuesday, January 22, 2002 12:49 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: DDE and the Use of Utilization Review Protocols for 278 Transacti ons Dear Chris: I do not think your question is a DDE question. It is more general. When we are required to use a standard transaction, we are not permitted to make it nonstandard by requiring different or extra data. The most explicit rule on this is 162.915: "A covered entity must not enter into a trading partner agreement that would do any of the following: (a) change the definition, data condition, or use of a data element or segment in a standard. (b) Add any data elements or segments to the maximum defined data set. (c) Use any code or data elements that are either marked "not used" ..., and (d) change the meaning or intent..." Yet there are some interesting windows here: 1. A payer might have to accept a standard claim but it does not have to pay it just because it is standard. It can ask for additional information as an attachment. What are the limitations on this? If a payer always requires attachment data, is it de facto making the claim nonstandard? 2. The explicit wording in the transaction rules is quoted above. But that wording speaks about a trading partner agreement. Say there is no agreement, written or otherwise. Say the payer says, if you want to get paid, send a standard claim but also send us the following attachment data; else you won't get paid. The payer has not changed the standard technically, but in fact it is changing the data required on a claim. So I will admit to not knowing the answers here. What do you think? Peter Peter Barry Peter T Barry Company Ozaukee Bank Building 1425 West Mequon Road Mequon Wisconsin 53092 (414) 732 5000 (national cell) [EMAIL PROTECTED] -------------------------- In a message dated 1/14/2002 7:59:18 AM Central Standard Time, [EMAIL PROTECTED] writes: > Subj: Re: DDE and the Use of Utilization Review Protocols for 278 > Transacti ons > Date: 1/14/2002 7:59:18 AM Central Standard Time > From: [EMAIL PROTECTED] (Christopher J. Feahr, OD) > To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED] > CC: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED], clstahlecker@ > hcs-is.com, [EMAIL PROTECTED] > > 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. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address.
