I would like to add onto the point Jan is making. Public Health folks, like myself, are also interested in collecting encounter data, which is why we went through the effort to have X12N approve a project proposal to create the Health Care Service Data Reporting implementation guide. This guide (X156) mines the 837 standard to include some necessary data elements not supported in the HIPAA 837 institutional, professional, or dental claim implementation guides. As part of the development process the authors through the Public Health Data Standards Consortium have reached out to a variety of potential users, including Medicaid. The principal contributors to date for the first iteration of this reporting guide have been state discharge system managers.
All potential users of this reporting guide are encouraged to participate in the reporting guide development activities through the Public Health Data Standards Consortium work group or through the ANSI ASC X12N Health Care (TG2) Claims (WG2) work group. I think we can all agree that a standard way to satisfy our particular program needs is the preferable course of action. Bob Davis Jan Root <[EMAIL PROTECTED]> on 01/11/2002 03:14:28 PM Please respond to <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] cc: Subject: Re: MEDICAID ENCOUNTER REPORTING Just as another voice - one Medicaid that I am familiar with came up with the same interpretation: the transaction between the MCO and Medicaid is not a HIPAA covered transaction therefore they were not required to use the 837. However, all the various parties got together and decided to use it anyway. They all had to use it in the covered transaction sense with various other parties and it met their reporting needs so they all decided to simplify their lives and not keep supporting the old proprietary report. Jan Root "Weber, Karen (DHS-PSD)" wrote: > We interpret the rule like this: Since the transaction that goes from the > Medicaid Health Plans/MCOs to the State is NOT a claim (since a claim is > defined as going from a provider to a health plan, and the MCOs aren't > providers), it is NOT required by HIPAA that this transmission be done in > the 837 format. So we're just keeping our old sort-of-proprietary reporting > format. > > > -----Original Message----- > From: Dave Murray [mailto:[EMAIL PROTECTED]] > Sent: Friday, January 11, 2002 8:14 AM > To: [EMAIL PROTECTED]; [EMAIL PROTECTED] > Subject: TCS: MEDICAID ENCOUNTER REPORTING > > Acting to some degree as a Medicaid Health Plan, our organization submits > encounter files to our state Medicaid agency. As of yet, we have not > received clarification as to how we are to continue to report encounters to > them in the 837 format. There appear to be several particularly troublesome > fields such as plan payment amount, plan payment date, invoice number, > subcapitation code, etc. I'm wondering what other states have done. > Anybody know where I can obtain Medicaid encounter reporting/837 guides? > > Thank you. > > Dave Murray > > > ********************************************************************** > 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.
