Jim,
Sorry, Jim, but I'm having trouble following your question! HIPAA
responsibilities usually sort out differently depending on the role(s) you
play. If you are a Property & Casualty insurer, HIPAA does not apply at
all, and you can use whatever features you like in the HIPAA IGs or within
the broader X12 standards specifications. There would be no such thing as
HIPAA compliance or a HIPAA mandate. Even if you wanted to use the
standards in as HIPAA-consistent a way as practical, that would still be
your choice, and you could use alternate code sets, etc., to the extent that
that was agreeable to your trading partners.
As to precedence where the regulations conflict with the guides from a
HIPAA-compliance perspective, the regulations will trump the guides wherever
the regulations are specific and the guides conflict with them. But
wherever the regulations are silent on the details, the guides are
authoritative. This is most obvious where the regulations specify what
medical code sets should be used, and the guides sometimes contain
conflicting information. Numerous other non-medical code sets are only
specified in the guides themselves.
But you have to understand that we are talking about X12 standards here.
There is no such thing as an X12N transaction, or an X12N standard,
regardless of what HHS says. And we are talking about X12N Implementation
Guides that have been adopted for use under HIPAA. Since these are X12N
Guides, not just "HIPAA Guides", they can document both HIPAA and non-HIPAA
uses of the transactions. With luck, any non-HIPAA instructions will be
noted as such. If you are not covered by HIPAA, you get to choose. If you
are covered, your choices are more constrained.
As to the claims data flows, if you are a payer, what you do with the data
you get on hardcopy is pretty much up to you. HIPAA becomes relevant if you
choose to do COB electronically, or if your provider wants to use the X12
claim status or claim payment transactions. If you are functioning as a
clearinghouse, and are picking up the data from the hardcopy claims and
sending them to another payer in behalf of the provider, then the
clearinghouse provisions would be effective.
What you are required to "send out" depends on what you are asked to send
out. If you are a payer, and a provider wants to do any of designated
transactions electronically, you are required to do so (using a
clearinghouse if you choose to) using the specified standard. If they don't
ask, then you aren't required to do so, but you are free to ask them to do
so, or even require that they do so if that fits your business model.
I could continue, but, absent any details on what your role(s) would be with
respect to HIPAA, it would be quite challenging to ensure any relevance to
your actual situation!
Good luck!
- Zon Owen -
(808)597-8493
----- Original Message -----
From: "James Driscoll" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>;
<[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>
Sent: Friday, July 27, 2001 1:23 PM
Subject: T&C set Final rule and 837 Implementation guides
The transaction and code set final rule explicitly excludes Property and
Casualty insurance carriers from the HIPAA mandates. However, the 837
Professional implementation guide specifically speaks to Property and
casualty claims as well as procedures directly related to automobile
insurance. For example, spinal manipulation. Is the final rule in direct
conflict with the 837P IGs? If so, what takes precedent?
Another issue that we are concerned with is the sending and receiving of
claims. If we receive a paper HCFA/UB92, DDE the claim into our system, can
we send it out in the X12 4010 and be HIPAA compliant? What happens if we
receive the claim electronically and drop it to paper, can we send this out
and be HIPAA compliant?
I know the regulation speaks to the difference between content verses
format. Has there been any discussion on this? Any workgroups or white
papers on this issue?
Thank you for your time.
Sincerely,
Jim Driscoll
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