Actually, I'd be curious to know what AHA means by their request. On the one hand, it seems redundant, because HIPAA clearly requires Payers to accept standard transactions.
On the other hand, AHA may be suggesting that payers not be permitted to request additional information -- however an 837 does not provide all the information necessary to process a claim. It seems to me that HHS and HIPAA recognize this because a claim attachment transaction is being developed. Finally, AHA says they are unhappy because payers don't process claims fast enough. However, HIPAA has nothing to do with what a payer does with a claim once it receives it, except that a payer can't process an 837 slower than it processes other claims. So the comments are either naive in not recognizing the fact that HIPAA requires payers to accept standard transactions, or the comments are ominous in that AHA is going to try to take HIPAA in directions it was not meant to go. I guess I'm also a little disappointed by these kinds of statements too. They seem to further the atmosphere suspicion, animosity, and gamesmanship where one side tries to "beat" the other side, that currently exists on both sides. What is really needed is to promote a positive, collaborative, "we're all in this together so lets make the best of it" atmosphere that we really need to achieve if all of the covered entities are to successfully work together to make HIPAA work. Ken Fody Independence Blue Cross -----Original Message----- From: David Frenkel [mailto:[EMAIL PROTECTED]] Sent: Friday, May 03, 2002 3:43 PM To: [EMAIL PROTECTED]; 'WEDi/SNIP ID & Routing' Subject: RE: FW: Article This is an interesting article from yesterday's AHA news. Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030 AHA urges HHS to require health plans to accept HIPAA claims AHA in a letter today urged HHS Secretary Tommy Thompson to adopt a rule or guidance requiring health plans to accept hospitals' claims compliant with the Health Insurance Portability and Accountability Act. According to the letter, one of the major administrative costs and sources of frustration facing hospitals is frequent claim payment delays, particularly by private payers. The final HIPAA regulation on electronic formats and code sets established national standards for electronic submission of claims, and makes clear that health plans are not permitted to require additional elements that deviate from those specified, the letter adds. Plans can be somewhat arbitrary in processing, leaving providers facing payment delays and engaged in "wasteful" resubmissions and reconciliation. The letter asks HHS to clarify that plans must accept HIPAA-compliant claims for contractual provisions with other entities covered under HIPAA and for state and federal prompt pay requirements. The letter will be at <http://www.aha.org>. CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute and delete the original message. Please notify the sender by E-Mail at the address shown. Thank you for your compliance.
