Dave,
The before/after issue is addressed by an HHS FAQ which does compare
level of service to prior to HIPAA.
Q: What level of service is required to be provided under HIPAA when an
entity implements batch and/or real time submission of a standard
transaction?
HHS responded to this question with the following FAQ answer: "45 CFR
162.925 states "a health plan may not delay or reject a transaction, or
attempt to adversely affect the other entity or the transaction, because
the transaction is a standard transaction." If the standard transaction
(e.g., ASC X12N 270/271) is offered in a batch (non-interactive) mode,
the health plan has to offer the same or higher level of service as it
did for a batch mode of transaction before the standards were
implemented by the plan. If a health plan offers the transaction in a
real time (interactive) mode, the level of service has to be at least
equal to the previously offered level for a real time mode of
transaction. If a transaction is offered through Direct Data Entry
(DDE), the level of service, again, has to be at least equal to the
level offered for the DDE transaction before implementation of the HIPAA
standard."
Thus, the current level of service will set the "bar" for each modality
(batch, real-time, DDE) that the program implements. Additionally, if
the program continues to offer non-standard methods in addition to HIPAA
compliant methods, such as telephone, fax, IVR, or direct data entry,
that same level of service (real-time) must be offered in a HIPAA
compliant way.
Many programs cannot discontinue vital communication methods such as
provider relations or fax-back support for eligibility or other
inquiries. In these cases, the standard transaction alternative must
replicate that level of service to be HIPAA compliant.
Finally, the HIPAA mandate as cited in the FAQ to not adversely effect
an entity or a transaction appears to apply equally to level of service
not just its' modality. Therefore, the same information needs to be
available in the standard transaction method as is available in any
optional, non-standard method a plan chooses to offer. So, for the
270/271 Eligibility Inquiry and Response require, at a minimum, a yes/no
response to "Is the client eligible today?" However, the transaction
supports additional levels of response related to beginning and end
dates, co-payment or deductible amounts, provider specific, and service
type eligibility information. See 270/271 Implementation Guide at
�1.3.7. So if a program provides more specific information via a
non-standard transmission method, such as a telephone inquiry, the "no
adverse effect" mandate appears to require that the standard
transmission implemented by the program also support that level of
information.
There may be room to argue on this one, but when you consider HIPAA's
purpose is to promote use of the standards by requiringe health plans to
support them and not give incentive to use other methods, it seems a
precarious position to take.
Leah Hole-Curry
Fox Systems, Inc.
>>> [EMAIL PROTECTED] 02/12/02 19:20 PM >>>
Ruth,
As far as I know, there are no "before" versus "after" requirements
for HIPAA. What anybody does before has no bearing on the
requirements for compliance after. Thus the undefined word "delay", a
relative as opposed to absolute term, would have to be operationally
and case-by-case defined unless DHHS provides some additional official
explanatory materials (e.g., the future Enforcement regulation).
Can you cite any regulatory language that I may have missed? Thanks.
Dave Feinberg
Rensis Corporation
206-617-1717
[EMAIL PROTECTED]
----- Original Message -----
From: "Tucci-Kaufhold, Ruth A." <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Tuesday, February 12, 2002 1:14 PM
Subject: RE: 270/271 question
Does this discussion fit under that category of "an entity cannot
delay a
transaction?"
My interpretation of that is an entity cannot delay any of the
transactions
from "before HIPAA". So, if their reply "today" includes more
information
than yes/no ... isn't there some sort of "obligation" to at least
provide
what is being given today? If not, and they say yes/no and say if you
want
more ... isn't that "delaying" the transaction?
Maybe I'm too logical?
Ruth Tucci-Kaufhold
UNISYS Corporation
4050 Innslake Drive
Suite 202
Glen Allen, VA 23060
(804) 346-1138
(804) 935-1647 (fax)
N246-1138
[EMAIL PROTECTED]
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