Would it be too simplistic to say "NOT USED" means "do not use"?
- do not fail to pay a claim because it is not present
- do not reject the 837 if it is not present
- do not echo it in an 835
- DO save it in an audit of what came in
- IF your adjudication system depends on it, either:
a) change your adjudication system, or
b) find another way to map it from the 837, since
you cannot reject an 837 that does not contain it
The question of rejecting a transaction that has a benign syntax error would
seem to be a business decision. It is not the payer's job to be the HIPAA
police and good stakeholder relations argues against delaying payment of a
claim because it contains a field you are going to ignore.
Two exceptions:
a) in testing one might reject it for fear its presence belies a bigger
problem
b) a certification agency would certainly fail to certify if it is present
and
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 25, 2001 5:59 AM
To: [EMAIL PROTECTED]
Subject: Re: 4010 Transaction vs. HIPAA Compliance
I have to disagree. The field says NOT USED and should not be used.
Anyone who sends this information is not in HIPAA compliance. I have asked
this question at several WEDI SNIP, etc. meetings and each time got the
same answer. The HIPAA implementation of these transactions say the field
is not used...so it cannot be used.
John Lilleston
Business Process Specialist
Verizon Information Technologies, Inc.
813-979-3225
[EMAIL PROTECTED]
Terry.Christensen@mutualo
fomaha.com To:
<[EMAIL PROTECTED]>
cc:
09/25/2001 07:42 AM Subject: Re: 4010
Transaction vs. HIPAA
Please respond to Compliance
transactions
I disagree. I believe if the field is marked "Not Used" you are not
required to use it. I don't think that is grounds for rejection. If data is
sent that is the prerogative of the sender, not using the data is the
prerogative of the receiver.
The receiver does not have to use, edit or scan the field. To just reject
the claim would not be in the true spirit of HIPAA.
Thank you,
Terry Christensen
[ IS Administration Simplification EDI
Telelphone: (402)351-6370
Fax: (402)351-8025
e-mail: [EMAIL PROTECTED]
Jan Root
<janroot@uhin To: [EMAIL PROTECTED]
.com> cc:
Subject: Re: 4010 Transaction
vs. HIPAA
09/24/2001 Compliance
08:26 AM
Please
respond to
transactions
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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