Paul,
No, payers are not required to respond at the line level if their
administration system does not have that functionality.
HIPAA ... generally ... does not touch on enhancing the functionality /
logic of the system you use to administer your business. It serves to
standardize how data is electronically received and submitted. For
example, you must be able to receive a claim with four Procedure Modifiers,
but HIPAA does not mandate that you enhance your Claims Pricing logic and
use all four Modifiers in pricing. That's why the phrase is "able to
accommodate".
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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transactions@w
edi.org To: <[EMAIL PROTECTED]>
cc:
01/16/02 12:46 Subject: 276/277 Question
PM
Please respond
to
transactions
277 Line Item Response Question:
On page 36 of the 276/277 Implementation Guide, section 2.2.3.6 (Line Item
Response), there is a statement that says,
"use loop ID-2220 when a request for claim status information is made
specifying the line level, and the payer is able to accommodate claim
status response at the line level."
Doe this mean that if a payer chooses not to respond at the line level to a
claim status inquiry, or it is not able to accommodate certain line-level
data elements, it does not have to?
Are payers required under HIPAA to respond at the line level to claim
status inquiries?
Any comments are welcomed!
Thanks,
Paul
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