I must disagree on one small point: You CAN require your trading partner to send electronically as a business decision. For example, Utah Medicaid now (and has for several years) accepts only electronic institutional 837 claims. Period. If a hospital sends them a paper claim, it is returned with instructions to submit it electronically. HIPAA does not pre-empt a payer's or a provider's business options to strongly encourage or require electronic submissions (some providers I know are beginning to pressure payers to send them 835s with EFT - no paper RAs, no paper checks). Clearly this is not a strategy that is undertaken overnight (I think Medicaid had to eliminate all their requirements for attachments for institutional claims before they could make the electronic submission requirement stick), but it remains a viable strategy if applied thoughtfully.
Jan Root "Heiert, David" wrote: > I don't think any of the legacy electronic formats will be allowed... > > I guess in your situation, the providers with have to send you either > paper or HIPAA compliant electronic files... I don't see any other > alternative... > > You are right, you can't force the providers to send electronic data, > BUT if they do it must be HIPAA compliant... That is how I understand it, > anyway.... > > -----Original Message----- > From: Tracy A. Mitchell [mailto:[EMAIL PROTECTED]] > Sent: Monday, February 18, 2002 12:09 PM > To: [EMAIL PROTECTED] > Subject: RE: Must providers/billers comply with all formats > > Wes, > > You have not understood what I wrote. As I am sure you know, some > providers still have their spouse hand write the claim and mail it in; > they certainly don't have EDI capability. Some of the ones that do send > in NSF formats WILL fall back to paper because they will not make the > investment in the systems necessary for HIPAA transactions. To think > otherwise is to not understand the feelings of providers that feel > squeezed from all sides, that feel they are surrounded by people with > their hand out and that hate managed care anyway. I'm not saying that I > agree with the sentiments. But anyone that has worked in provider > relations knows the sentiment is there. I was hoping that I could > continue to RECEIVE the NSF files from those providers that send them. > That is why I asked the question in the first place. There seems to be > disagreement on whether or not it is allowable for me to do so. > > My company WILL convert these claims to HIPAA formatted outbound > transactions for any payer that wishes to receive them. When we send EDI > files currently, we send only ANSI outbound transaction (3041 for some > and 4010 for those that can receive them). But we can not force the > providers in our network to send in HIPAA transactions. Yes in the long > run there will be a nice flow of EDI claims but in the short run my > inbound EDI volume will likely drop and my outbound volume will > increase. > > Mr. Tracy A. Mitchell > Director Information Services > Arizona Foundation for Medical Care > > -----Original Message----- > From: Rishel,Wes [mailto:[EMAIL PROTECTED]] > Sent: Saturday, February 16, 2002 11:23 AM > To: [EMAIL PROTECTED] > Subject: RE: Must providers/billers comply with all formats > > Tracey, > > You seem to believe that you will be forced go back to paper if you are > ready on the new format and the payer is still on the old format. That > is > not an inescapable conclusion. One would hope that your approach to > HIPAA > would allow you to selectively use an old format or the new format on a > per > health plan basis. This should not be too much of a challenge since you > currently are required to use different formats for different health > plans. > > Your job is to use that capability to switch to the new format for each > health plan. > > It has never been remotely possible that all health plans would switch > to > the new formats at exactly the same time, so this has always been a > requirement. The extension just prolongs the time frame where you must > continue to support multiple formats. > > Wes Rishel > Board Chair, Health Level 7 > Vice President, Research Director > Gartner Research, Healthcare > Alameda, CA > 510 522 8135 > [EMAIL PROTECTED] > See us at the Gartner Healthcare Business and IT Summit > 15-17 April 2002 > Sheraton Boston Hotel > Boston, MA > > http://www3.gartner.com/2_events/conferences/hit4/hit4.jsp > > -----Original Message----- > From: Tracy A. Mitchell [mailto:[EMAIL PROTECTED]] > Sent: Friday, February 15, 2002 2:10 PM > To: [EMAIL PROTECTED] > Subject: RE: Must providers/billers comply with all formats > > Darn, I was afraid of that. We are a not-for-profit repricing PPO. Our > board of trustees is made up of MDs and DOs. I love EDI files and my > company will be HIPAA ready this year, but many, many providers have old > systems that they will not upgrade by Oct 2003. So, I suspect my > inbound EDI volume will drop and my data entry cost will go up over the > next few years. I was hoping that I could a least keep the ones that > could send NSF formats. I would support both. > > Oh well, at least the payers are suddenly returning my phone calls > regarding EDI. > > Mr. Tracy A. Mitchell > Director Information Services > Arizona Foundation for Medical Care > > -----Original Message----- > From: Sayman,William [mailto:[EMAIL PROTECTED]] > Sent: Friday, February 15, 2002 1:31 PM > To: '[EMAIL PROTECTED]' > Subject: RE: Must providers/billers comply with all formats > > Covered entities are required to use standard transactions. > > � 162.923 Requirements for covered entities. > (a) General rule. Except as otherwise provided in this part, if a > covered > entity conducts with another covered entity (or within the same covered > entity), using electronic media, a transaction for which the Secretary > has > adopted a standard under this part, the covered entity must conduct the > transaction as a standard transaction. > > ********************************************************************** > 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. ********************************************************************** 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.
