Agreed.
Larry
-----Original Message-----
From: Zon Owen [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 25, 2001 2:53 PM
To: [EMAIL PROTECTED]
Subject: Re: 4010 Transaction vs. HIPAA Compliance
Aloha!
I would generally agree (1) that it would usually be pointless to include
anything in the "Not Used" items, and that (2) it could still be a business
decision as to whether or not a receiver rejects it, as long as there is
nothing in a trading partner agreement that requires it, and as long as it
is not used. Given that, I could still see a couple of situations where you
might have a legitimate need to have it present:
First, it could be a non-HIPAA claim. E.g., it could be for a non-covered
payer, such as a Property & Casualty insurer. Or it could be for a service
not considered to be health care under HIPAA, but otherwise billable via the
837.
Second, it could be a multiple payer claim in which a secondary or later
payer was not covered by HIPAA. HIPAA provides for saving and forwarding
any information on a multi-payer claim that could be of use to a later
payer. If such a subsequent payer is not covered by HIPAA, they could have
some data requirements that were quite compatible with the X12 standard, but
not with the HIPAA Implementation Guide.
While this sounds a bit hypothetical, I imagine that some organizations will
see these cases and others. So how do we handle such combinations of HIPAA
and non-HIPAA payers?
- Zon Owen -
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