Marsha,
Could you site the passage regarding not requiring adding functionality that does not currently exist? Under CFR45 162.925 "If an entity requests a health plan to conduct a transaction as a standard the health plan must do so."
We are really struggling with this because it means adding functionality to our systems that do not currently exist to support all the standard transactions.
Kris Owens
Senior Project Manager - HIPAA Project
Presbyterian Healthcare Services
505/923-8108
[EMAIL PROTECTED]
HIPAA means a higher level of healthcare.
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
Sent: Monday, October 08, 2001 10:21 AM
To: [EMAIL PROTECTED]
Subject: Re: 835 Select
Jim,
I think we should be cautious here, with your statement.
Many providers will want to be paid with electronic funds
transfers ( after all Congress did require designation of a Claim
Payment
Standard in HIPAA) and that will involve the banking system.
Our interpretation of the Final Rule indicates it does not require
adding functionality that does not currently exist. Therefore if a
Payer in this example, does not currently have functionality to offer
electronic funds transfer, or clearinghouse transfer as payment
options ... they are not required by HIPAA to make that enhancement.
By way of explanation about the 820 and 835 specifically, page 50333
of the Rule says:
The implementation specifications for the ASC X12N 835 and 820
transactions contain two parts,
- a mechanism for the transfer of dollars and
- one for the transfer of information about the payment,
and allow these two parts to be transmitted separately.
Consistent with the implementation specifications, actual payment may
be sent in a number of different, equally acceptable ways, including
check and several varieties of electronic funds transfer.
So our belief is that we need to support the options of sending and
receiving data electronically. We are not required to add
functionality / logic to support the processes required to offer
transferring funds electronically, since the system does not support
it today.
Marsha
Verizon Information Technologies, Inc.
Managed Care Division Phoenix, AZ
Phone - 602.678.6042
Fax - 602.678.6331
E-mail - [EMAIL PROTECTED]
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---------- Original Text ----------
From: <[EMAIL PROTECTED]>, on 10/6/01 12:22 PM:
To: smtp[<[EMAIL PROTECTED]>]
Your question may bring up more options than you might have expected.
Providers may contact you through clearinghouse/remittance processing
vendors, through their banks, or directly, and ask for a variety of
claim
payment options. A provider opting to receive the electronic
remittance
information through a network of clearinghouses and vendors will have
them
contact you indicating that those vendors are ready to accept/test on
behalf
of that provider. Many providers will want to be paid with electronic
funds
transfers ( after all Congress did require designation of a Claim
Payment
Standard in HIPAA) and that will involve the banking system. There are
several execution options including sending the 835 remittance data
with the
electronic funds transfer through the banking system or sending the
money and
data separately. All of these can be accomodated by the
HIPAA-compliant 835.
By the way, set up of electronic payment options should not be done
based on
incoming information on an 837.
Jim Moynihan
McLure-Moynihan, Inc.
Agoura Hills, CA 91301
818-706-3882
[EMAIL PROTECTED]
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