Unfortunately, I have not followed all of this thread (as I wish I had
now), but I believe the IG itself specifically answers this question
(perhaps someone has already pointed this out, and if so I apologize for
restating it). Having considered what I have read of this thread, I would
agree with Rachael. Reasons follow:
Not used means literally that, 'not used". Note the wording; "should not
be used when complying with this
implementation guide." (see below: from page 49 of 837-P IG:)
Compliance applies to the IG requirements not just the X12N format which is
included within the IG (which is sometimes confusing as to which is which
in the IG guides from WPC).
Complying (e.g. compliance) is one definition of the difference between a
transaction which must be accepted and a transaction which may NOT be
accepted. A deviation from the IG standard format (no matter how small)
would appear to fall under the category of an "additional format" (see HHS
AS FAQ excerpt below). It would also appear to violate the trading
partner agreement limitation provisions within the CFR rules.
from page 49 of 837-P IG:
Industry Usages:
Required This item must be used to be compliant with this implementation
guide.
Not Used This item should not be used when complying with this
implementation guide.
Situational The use of this item varies, depending on data content and
business
context. The defining rule is generally documented in a syn-tax
or usage note attached to the item.* The item should be used
whenever the situation defined in the note is true; otherwise, the
item should not be used.
* NOTE
If no rule appears in the notes, the item should be sent if the data
is available to the sender.
HHS AS FAQ excerpt Question:
Is it permissible for health plans to continue to accept additional formats
as well as the standard transactions adopted under HIPAA past the effective
date of the final regulation?
ANS: 9/17/2001:
Section 162.923(a) of the regulation requires a covered entity that
electronically conducts a transaction adopted under part 162 of the
regulation, with another covered entity, to conduct the transaction as a
standard transaction. Health plans may continue to accept additional
electronic formats after the transaction and code set final rule compliance
date only if the submitter is NOT a covered entity under HIPAA.
Regards, and sorry to weigh in so late on this, Mark
[EMAIL PROTECTED] on 09/26/2001 01:27:41 PM
Please respond to <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
cc:
Subject: RE: 4010 Transaction vs. HIPAA Compliance
I appreciate the barrage of emails on the topic of "Not Used" wording in
the IG.
A number of highly respected individuals have commented on this critical
issue
and unfortunately not all are in agreement. At this point I do not have a
good
feeling to the response that I would pass onto my organization
It seems to be the time to contact HHS or whomever has the official word
on
this issue and request an official interpretation. Would it be best for
the
Chairman of the WEDI Transaction Workgroup to be the initiator of this
question
so the question that is asked is consistent with all the comments we have
received on the issue?
Thanks,
Buzz
Robert P. "Buzz" Bisanz
Project Manager - HIPAA Program
NASCO
Atlanta, Georgia
[EMAIL PROTECTED]
"Rachel Foerster" <[EMAIL PROTECTED]> on 09/25/2001 07:43:24 PM
Please respond to [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
cc: (bcc: Robert Bisanz/NASCO)
Subject: RE: 4010 Transaction vs. HIPAA Compliance
Fax to:
Dale,
I disagree. The receiver MUST reject the transaction since it is not HIPAA
compliant and the regulations prohibit conducting non-standard
transactions,
or be subject to fines and penalties for violating the standard transaction
as specified.
The issue of syntax compliance and IG compliance and how to report both
back
to the originator is still an unsolved issue in my mind.
We should keep the two issues separate.
Rachel Foerster
-----Original Message-----
From: Gibbs, Dale [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 25, 2001 9:09 AM
To: '[EMAIL PROTECTED]'
Subject: RE: 4010 Transaction vs. HIPAA Compliance
The IG is an implementation guide to a standard. Therefore you could be
compliant with the standard but not with the implementation guide. That is
why you do not reject if a 'not used' element is used.
Dale Gibbs
Sr. Business Analyst
Sterling Commerce
(614) 793-7155
-----Original Message-----
From: Michael Jimenez [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 25, 2001 8:02 AM
To: '[EMAIL PROTECTED]'
Subject: RE: 4010 Transaction vs. HIPAA Compliance
Hi,
The problem is that a transaction that is not compliant with the IG is not
a
standard transaction. The attribute "Not Used" implies that a particular
data element is not used under the ASC-X12 HIPPA Implementation. And if
receivers (covered entity) accepts non-standard transactions, they will be
breaking the law.
Mike
Michael Jimenez
ADS
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 25, 2001 7:43 AM
To: [EMAIL PROTECTED]
Subject: Re: 4010 Transaction vs. HIPAA Compliance
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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