Dear Amanda: In your message below, you ask the question, "Once a provider has submitted a transaction electronically to a payer, does the provider always have to send that transaction electronically?"
First, I would like to address that question, then pose another question: 1. My understanding is that the rules do not contain any mandate on a provider to send or receive electronic transactions. The only mandate is that, if it sends or receives electronic transactions, they must be standard, either directly or through a clearinghouse, or they must be through the DDE exception. If this understanding is correct, a provider can elect to send and receive standard transactions with some plans and not others. With any given plan, it may elect to send and receive only certain standard transactions and use paper or telephone for others. With a single plan, it may chose to send or receive some but not all transactions of a given type. And the provider may go standard for some part of its business now and later change back to paper and telephone. 2. The more interesting question is about the provider's status as a covered entity. Can a provider undo its covered status by reverting to paper? Once, after October 16, 2002, a provider transmits an electronic transaction covered by the Transaction Rules, it becomes a "covered entity". Then, say, it reverts back entirely to paper. But for privacy purposes, is it still a "covered entity"? We note that, if a provider never sends an electronic transaction, it never becomes a covered entity. But if it sends just one, did it touch the third rail, is it covered now forever? Peter Peter Barry Peter T Barry Company Ozaukee Bank Building 1425 West Mequon Road Mequon Wisconsin 53092 (414) 732 5000 (national cell) [EMAIL PROTECTED] --------------------- In a message dated 10/1/2001 5:25:10 PM Central Daylight Time, [EMAIL PROTECTED] writes: > Subj: Once electronic, always electronic? > Date: 10/1/2001 5:25:10 PM Central Daylight Time > From: [EMAIL PROTECTED] (Amanda Dorsey) > Reply-to: <A HREF="mailto:[EMAIL PROTECTED]";>[EMAIL PROTECTED] </A> > To: [EMAIL PROTECTED] > > I hope this is the appropriate group with whom we would share a lingering > question. One of our assessment working groups has an ongoing debate on > whether providers have a choice in their claims-submission method. We have > two groups who interpret the regs two ways and one group that maintains this > isn't specifically addressed in the regs at all. Our question is: > > Once a provider has submitted a transaction electronically to a payer, does > the provider always have to send that transaction electronically? > > We gratefully appreciate anyone's answer or thoughts on this question. > > Regards, > Amanda > ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
