This does not imply that if the provider is currently receiving electronic RAs today that the provider must accept all the transactions. The provider can send an 837 and receive a paper RA (health plans are required to be able to send the 835 whether the provider wants it or not ... but cannot refuse to send any HIPAA transaction.).
Providers are allowed to "mix up" the transactions. see: p50314 FR ... A.(Applicability)1.Electronically Transmitting Transactions. last paragraph of the 3rd column. Ruth Tucci-Kaufhold UNISYS Corporation 4050 Innslake Drive Suite 202 Glen Allen, VA 23060 (804) 346-1138 (804) 935-1647 (fax) N246-1138 [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Thursday, October 25, 2001 3:57 PM To: [EMAIL PROTECTED] Subject: RE: Issue from a recent conference I strongly disagree. 162.925 (the rule you quote as authority) is not applicable to providers who conduct PAPER submissions. 162.925 et al are only applicable to providers who conduct (submit) EDI transactions. The definitions on applicability are clear on this: 50365 Federal Register / Vol. 65, No. 160 / Thursday, August 17, 2000 / Rules and Regulations � 160.102 Applicability. Except as otherwise provided, the standards, requirements, and implementation specifications adopted under this subchapter apply to the following entities: (a) A health plan. (b) A health care clearinghouse. (c) A health care provider who transmits any health information in electronic form in connection with a transaction covered by this subchapter. "Tucci-Kaufhold, Ruth A." To: "'[EMAIL PROTECTED]'" <Ruth.Tucci-Kaufhold@u <[EMAIL PROTECTED]> nisys.com> cc: Subject: RE: Issue from a recent conference 10/25/2001 02:55 PM Please respond to transactions The provider can submit paper and request that a payer provide an 835 remittance. The rule allows this ... the health plan cannot refuse to provide that provider with the 835 if that provider asks the health plan to do so. (p. 50469 ss162.925) The issue of the lack of data can be solved by the payer requiring those data elements from the provider ... that is permissible. Ruth Tucci-Kaufhold UNISYS Corporation 4050 Innslake Drive Suite 202 Glen Allen, VA 23060 (804) 346-1138 (804) 935-1647 (fax) N246-1138 [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Thursday, October 25, 2001 2:41 PM To: [EMAIL PROTECTED] Subject: RE: Issue from a recent conference I haven't been fully following this thread, but on the question of a submitter "requiring" an 835 response from a paper submission, I disagree strongly. Paper transaction submissions are exempt from HIPAA transaction standards. HIPAA transaction requirements are expressly limited to EDI transactions. The content (lack of) of the paper claim submission would make a compliant 835 EDI response difficult if not impossible. I fail to see how a submitter, who (at their option, by sending 'paper') 'exempts' a transaction from HIPAA, may 'un-exempt' the same transaction once it reaches the payor, by requiring an EDI response from the payor. Where is this written? Lastly, a non-compliant EDI response to a paper submission, would place only the payor in violation of HIPAA. To permit a submitter to force a payor to respond to a paper submission with a non-compliant EDI transaction, thereby risking violation and fine, where the reason for the non-compliance is solely due to the format and content of data presented by the submitter, is absurd. "Hauser, Tarry" <THauser@mahealt To: "'[EMAIL PROTECTED]'" hcare.com> <[EMAIL PROTECTED]> cc: 10/25/2001 02:31 Subject: RE: Issue from a recent conference PM Please respond to transactions Thanks all....I do think your approach Steve - and that of Jonathan - is/are the most reasonable given current circumstances. Though it is true that it does raise more questions. -----Original Message----- From: Hanson, Steve [mailto:[EMAIL PROTECTED]] Sent: Thursday, October 25, 2001 1:24 PM To: '[EMAIL PROTECTED]' Subject: RE: Issue from a recent conference We assume that this is a matter that individual providers must work out with payers, and are modifying our provider demographic data to include controls for this. We also assume that this control applies regardless of whether or not we receive an 837; that is, we must issue an 835 to a provider who has previously requested this method of payment for both 837 and paper claim submissions. Unfortunately, I can't tell you what parts of the regs we were looking at when we reached this conclusion. Steve Hanson Senior Product Technical Consultant, The TriZetto Group, Inc. "Pluralitas non est ponenda sine necessitate" - Ockham's Razor (14th century) for which my favorite corollary is: The simplest solution that is both necessary and sufficient is best. > -----Original Message----- > From: Hauser, Tarry [SMTP:[EMAIL PROTECTED]] > Sent: Thursday, October 25, 2001 8:30 AM > To: '[EMAIL PROTECTED]' > Subject: Issue from a recent conference > > > > "There did not seem to be a definite answer on how we know that we should > send an 835 transaction back when we receive an 837. At one point there > was to be a routing # if the Provider wanted the 835 back. However, there > is nothing in the data field such as a routing # to know." > > This question cam back to me after one of our own attended an SPBA > conference. Do we have an answer for this anywhere in the regs? > > Tarry L. Hauser > Applications Specialist > Medical Associates Health Plans > 700 Locust Street Ste 230 > PO Box 5002 > Dubuque, IA 52004-5002 > (319)584-4830 > FAX (319)556-5134 > > > > > ********************************************************************** > 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. ********************************************************************** 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. ********************************************************************** 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. ********************************************************************** 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. ********************************************************************** 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. ********************************************************************** 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. ********************************************************************** 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.
