There has been much said on this subject on the past few days, and most all is relevant. My comment is as follows and pertains to the "invisible" statement concerning clearinghouses below. The scenario is that a provider sends non-complainant data to the clearinghouse is the clearinghouse really going to have enough information to make a compliant transaction if only for a micro-second. In other words are all the "required" fields going to be present from the provider? And while it is feasible to "cross-walk" many of the code sets what will the clearinghouse do with provider code sets that cannot be "cross walked" Further once the payer gets the transaction, hopefully, Is all of the information initially submitted by the provider going to be returned to the provider? I think not. What is the provider then going to do when say receiving back a 835 that may not have a lot of the information that the provider initially submitted on the non-compliant claim? Just some of my thoughts on this much discussed subject. Regards
>>> [EMAIL PROTECTED] 02/18/02 12:55PM >>> David, Yes, it is true. Very few of our Providers will be changing their systems to produce HIPAA compliant transactions. The clearinghouse makes the transaction change invisible to the provider. Hope this is helpful. Terri Bradley Cox HealthPlans Springfield, MO -----Original Message----- From: Heiert, David [mailto:[EMAIL PROTECTED]] Sent: Monday, February 18, 2002 11:41 AM To: '[EMAIL PROTECTED]' Subject: RE: Must providers/billers comply with all formats Is that true? Providers can send non-compliant electronic data to a clearinghouse?? Not according to what I understand.. Which could be way off.... Now, they could send you paper (or a fax) and you could convert that to HIPAA transactions for them... I think that would be OK... -----Original Message----- From: Claudia J. Egan [mailto:[EMAIL PROTECTED]] Sent: Monday, February 18, 2002 12:36 PM To: '[EMAIL PROTECTED]' Subject: RE: Must providers/billers comply with all formats Why not contract with the providers to be their clearinghouse? If you take on the burden of providing compliant transactions to their payors, the providers can send you whatever non-compliant transactions they wish. Of course, the burden of converting all the transactions may be too large ($$) . . . . Claudia Egan -----Original Message----- From: Heiert, David [mailto:[EMAIL PROTECTED]] Sent: Monday, February 18, 2002 11:21 AM To: '[EMAIL PROTECTED]' Subject: RE: Must providers/billers comply with all formats 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. ********************************************************************** 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.
