Jan,
First if they are sending you a 4010 837 you are using the ANSI X12 standard
and not the HIPAA IG. HIPAA IG documents contain version 004010X??? where
??? is replaced with 061 through 098 respectively based on transaction set
being used. Second, you map data based on the implementation guide and
ignore other segments and elements.
An implementation guide contains the instructions for filling out a
standard. It is not a standard in itself. Therefore, if other
segments/fields are used that are valid in ASC X12 but are not part of the
HIPAA implementation guide (i.e., not used), they should be ignored when
mapping to your application. Do not save nor hold any data that is not
defined in the implementation guide.
Dale Gibbs
Sr. Business Analyst
Sterling Commerce
(614) 793-7155
-----Original Message-----
From: Jan Root [mailto:[EMAIL PROTECTED]]
Sent: Monday, September 24, 2001 9:27 AM
To: [EMAIL PROTECTED]
Subject: Re: 4010 Transaction vs. HIPAA Compliance
Chris
The short answer to your question is that if an element/segment/loop is
marked
"Not Used' then it is NOT USED. If a provider is sending you a HIPAA 4010
837
with marital status data then you can reject it as a non-HIPAA-compliant
transaction. This is sort of what having a national standard is all about:
everyone doing it the same way. This way you know what to spend your
limited
resources on: building a field for marital status on an incoming HIPAA 837
is a
waste of your resources.
Anyway, that's my non-official, non-legal opinion!
j
"Graff, Chris" wrote:
> Hello all. We are working on a HIPAA data store and claims processing
> application. There is a question that has been plaguing our minds here.
>
> If you look at the 4010X098 or 4010X096 manuals, there are many fields
that
> state "Not Used." Because these fields are not used, I was under the
> assumption that we should not store this data. For the majority of these
> fields, this is a no-brainer. Some of the NM1 loops specifically can hold
> information that would never pertain to certain entities within the loop.
> For instance, there is no reason to keep track of NM111(Entity
Identifier's)
> for the submitter loop.
>
> Some pieces of data, however, seem to be elements that providers or payers
> may be keeping track of at the moment. One in particular that we found
was
> the marital status element, which is on a normal UB-92(locator 16), but is
> listed as not used in the 4010X096 manual. Once we found this difference
a
> number of different questions came up.
>
> 1. Do we accommodate for this field because it is on the form, and there
> might be a chance that this particular data element might be passed
through
> our processing system?
>
> 2. If we accommodate for this field, does that make us not HIPAA
compliant
> because we have claims running through the system that contain non-HIPAA
> compliant data?
>
> 3. Should we just accommodate all the possible fields that could appear
on
> a 4010 even though it states in the manuals that they are specifically not
> used? Once again would we then be not compliant if we did?
>
> Any thoughts on these questions would be greatly appreciated.
>
> Thank you,
>
> Chris Graff
> United Wisconsin Proservices
> (414)226-6022
> 800-822-8050 x6022
> [EMAIL PROTECTED]
>
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