I'd be interested in other's thoughts as well as we are in the same
position.  To date the general consensus has been this practice is
considered internal as we already 'own' the paper claim.  The outside vendor
may remain indefinitely in v3051 format and would not be bound by the v4010
format and/or HIPAA rules and regs. 

Donna M. Hayward
A CIGNA HealthCare - EDI GATEWAY HIPAA Project Manager
*  Bloomfield: 860.226.3134  Ntwk: 572-3134   Fax:  860.226.7573
*       e-mail: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> 
 

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        -----Original Message-----
        From:   Anita Mosley [SMTP:[EMAIL PROTECTED]]
        Sent:   Tuesday, January 15, 2002 2:24 PM
        To:     [EMAIL PROTECTED]; [EMAIL PROTECTED]
        Subject:        Paper Claims into a Paper-less System

        We currently out-source our mail handling to an outside vendor.  One
of the things they do for us is to key paper claims that have been mailed to
us into our "translated EDI" format and send them to us for processing.  In
this instance we have received paper claims from the provider/subscriber and
NOT EDI.

        Questions have come up:
        - Are they required to send us HIPAA compliant formats?
        - Are they considered to be a "clearing house" so we can continue to

          receive non-compliant translated data from them?
        - Is this data not covered at all (from a transaction code set / EDI

          perspective) because we have received paper claims and are using 
          external/internal resources to convert them to an electronic
format for auto-
          adjudication?
        - Other options/opinions?

        I think we understand how this practice is affected by the privacy
and security pieces.

        Thank you.

        [EMAIL PROTECTED] 


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