Chris, read page 82799 on the Privacy Rule - third column where it describes what is
excluded as a Health Plan:
Any policy, plan, or program to the extent that it provides, or pays for the cost of,
excepted benefits that are listed in section 2791(c)(1) of the PHS Act, 42 U.S.C.
300gg-91(c)(1).
Cut and Paste from that section note item D
(c) Excepted benefits
For purposes of this subchapter, the term ``excepted benefits''
means benefits under one or more (or any combination thereof) of the
following:
(1) Benefits not subject to requirements
(A) Coverage only for accident, or disability income insurance,
or any combination thereof.
(B) Coverage issued as a supplement to liability insurance.
(C) Liability insurance, including general liability insurance
and automobile liability insurance.
(D) Workers' compensation or similar insurance.
(E) Automobile medical payment insurance.
(F) Credit-only insurance.
(G) Coverage for on-site medical clinics.
(H) Other similar insurance coverage, specified in regulations,
under which benefits for medical care are secondary or incidental to
other insurance benefits.
Diana DeWeese
Illinois Dept of Human Services.
>>> [EMAIL PROTECTED] 01/15/02 09:36AM >>>
If a covered provider submits a claim for services provided under a
workmans comp policy, how is that NOT a covered transaction?
-Chris
At 06:58 AM 1/15/02 -0700, C.J. Major wrote:
>You kind of answered the question yourself. HIPAA only governs the
>defined covered transactions. If a transaction is a non-covered
>transaction, HIPAA does not govern what to use and how you send
>the transaction to anyone (covered entity or not).
>
>CJ
>--------------------------------------------------------
>C.J. Major
>Consultant - Comsys, Inc.
>Arizona Department of Health Services
>Division of Behavioral Health Services
><mailto:[EMAIL PROTECTED]>[EMAIL PROTECTED]
>T. 602.553.9082
>F. 602.954-7259
>--------------------------------------------------------
>
>
>
> >>> [EMAIL PROTECTED] 1/15/02 4:15:09 AM >>>
>A covered entity (such as a provider) sends a non-covered transaction (such
>as a Workers' Comp claim) to a covered entity (such as a payer who services
>both Workers' Comp and other covered services) using a named transaction
>(such as the 837 professional version 4010) and uses code values that do not
>violate the 837 version 4010 standard, but are not covered in the HIPAA
>implementation guide. The payer then sends an 835 version 4010 payment /
>remittance advice for the same transaction back to the provider, using code
>values that do not violate the 835 version 4010 standard, but are not
>covered in the HIPAA implementation guide for the 835 version 4010.
>
>Are either of the transactions or entities non-compliant anywhere in this
>process?
>
>Ken Steen
>VP, Information Systems
>Apollo Enterprises
>
>
>
>
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>
>
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Christopher J. Feahr, OD
http://visiondatastandard.org
[EMAIL PROTECTED]
Cell/Pager: 707-529-2268
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