Hi Karen!

A number of payers have expressed an interest in using the mandated 278
Request Response guide for notifications.   Currently, there are three
implementations of the 278.  They are as follows:

278 Health Care Services Review - Request and Response - this is the HIPAA
guide
278 Health Care Services Review - Inquiry and Response (4010X059)
278 Health Care Services Review - Notifications (4010X111) - this is a
draft.

Payers that are currently using the 278 Request Response, are using some
codes in addition to the codes in the HIPAA guide to indicate that this is
a notification.

X12N-TG2-WG10 determined that it would be best to propose a recommended
workaround for basing a notification and an associated acknowledgement
response on the current 278 Request Response HIPAA guide.  The intent was
to ensure that, for providers dealing with multiple payers, the format and
coding of these notifications would be consistent across payers.

Participants in the workgroup are also in the process of evaluating the
usefulness of the 4010 Notification guide currently on the WPC website.
The workgroup is determining, for 4050, if  we want to modify the business
uses in the guides as follows:

Notifications of the following type should be incorporated as a business
use in the 278 Request and Response implementation guide.
Notifications that represent a single patient event sent by a provider to a
payer/UMO where the UMO wishes to acknowledge receipt of the notification
and possibly assign a receipt number.

Notifications of the following type should be kept in the 278 Notification
guide.
One to many notifications sent as information copies between a TPA and
Payer or other parties.  This implies that the 278 Notification guide could
change to support the submission of multiple patient events within a
transaction.

We are currently drafting a new version of this workaround for the 278
HIPAA guide and will post it to the X12N-TG2-WG10 listserv for discussion.
If you are interesting in subscribing to the WG10 listserv, please send me
an email or submit your request to subscribe through the X12 website.




"Ausum, Karen" <[EMAIL PROTECTED]> on 03/18/2002 03:50:13 PM

To:   "'[EMAIL PROTECTED]'" <[EMAIL PROTECTED]>
cc:
Subject:  278 Transaction(s) Questions


Are there any insurers that do  'notifications' and not certifications,
and,
if so, are you planning on using the mandated 278 and how are you planning
to use it?  In addition, is there anyone planning on using the unmandated
278 - Notification transaction?   Thanks very much,

Karen Ausum
BCBSFL
HIPAA-AS Project Team
DC6-6
(904)905-6403
[EMAIL PROTECTED]





Blue Cross Blue Shield of Florida, Inc., and its subsidiary and
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