Re: Covered Transactions

[C.J. Major]

From the text of the final regulation, Federal Register, page 50320:   Response: We recognize that non- HIPAA entities such as workers� compensation programs and property casualty insurance accept electronic transactions from health care providers, however, the Congress did not include these programs in the definition of a health plan under section 1171 of the Act. The statutory definition of a health plan does not specifically include workers� compensation programs, property and casualty programs, or disability insurance programs, and, consequently, we are not requiring them to comply with the standards. However, to the extent that these programs perform health care claims processing activities using an electronic standard, it would benefit these programs and their health care providers to use the standard we adopt.   CJ >>> [EMAIL PROTECTED] 1/15/02 8:36:07 AM >>> 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 > > > > >********************************************************************** >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. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268        ********************************************************************** 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.