I just came back from vacation and saw this. I am uncomfortable with this statement
for several reasons.
First, if the "non-traditional" information is necessary on every vision claim, it
should be considered claim information and not attachment information. If it is claim
information, it can only be submitted as part of the standard. If it is not part of
the standard, it cannot be submitted electronically, and providers cannot be forced to
send it on paper or any other way. A health plan must be able to process claims
electronically using the standard.
Attachment information should only be used for non-routine claims.
Stanley Nachimson
Office of Information Services, CMS
410-786-6153
>>> [EMAIL PROTECTED] 08/20/01 04:35PM >>>
Dear Group,
I'm beginning a conversation with a large commercial vision payor and I was
planning to make the following statement to them. I would like to know if
it is factually correct, as written. If I'm wrong or even "slightly off
base" regarding any part of it, I would appreciate your comments:
"If [VISION PAYOR] requires "non-traditional-claim" information (e.g.,
specific details about the frame, lenses, coatings, spectacle-Rx, etc.,
commonly included in the doctor's "purchase order") to process/pay a claim,
then the totality of that information plus the 837-information would
constitute "The Claim". Since a HIPAA-standard does not exist for the
information normally found on a lab purchase order, it will not be legal
after 10-16-02 for [VISION PAYOR] to receive that information
electronically. Information necessary for routine claim adjudication that
cannot be placed into a standard "837 claim" or into one of the standard
"claim attachments" (proposed by HL7 and the Claim Attachment Committee)
will have to be sent to the vision plan or its exclusive business agent,
via paper. A second alternative would be for [VISION PAYOR] to adjudicate
claims without this information."
Thanks very much for your feedback.
-Chris
Christopher J. Feahr, OD Vision Data Standards Council
Executive Director http://visiondatastandard.org
Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
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