Yeah - this is the email I had that I was running with - but when I explained this to Kay she said it isn't an intraplan transaction - which is right in the "literal" meaning, but I think CMS was interpreting in general and not literal like Kay was making it. Maybe I am wrong but it seems like the intent was for billing purposes and not reporting. Oh well money talks!
> -----Original Message----- > From: Karen Weber [SMTP:[EMAIL PROTECTED]] > Sent: Friday, January 11, 2002 9:52 PM > To: [EMAIL PROTECTED] > Subject: RE: MEDICAID ENCOUNTER REPORTING > > > > To answer Doug's question: Encounters are zero-pay transactions (because > payment has already been made, in the form of capitation to the provider), > which are sent from a provider to a health plan. > > > > At 05:33 PM 1/11/2002 -0500, you wrote: > > > > In talking to CMS staff at the WEDI SNIP Summit in Orlando, the > interpretation that > I received was that the transaction would be considered an > intra-plan > transaction and > that any format the parties argreed to would be acceptable. > However, you > could certainly > agree to use the standard transaction. > > > > Steven Reynolds > Chief Information Officer > Horizon Mercy > 275 Phillips Boulevard > Trenton, New Jersey > 08618-1426 > www.horizon-mercy.com > <http://www.horizon-mercy.com/> > E-mail: > [EMAIL PROTECTED] > Phone: 609-538-0700 X 5112 > Fax: 609-538-0858 > Cell: 609-206-4681 > > > -----Original Message----- > From: Cassavar, Doug [ <mailto:[EMAIL PROTECTED]>] > Sent: Friday, January 11, 2002 5:06 PM > To: '[EMAIL PROTECTED]' > Subject: RE: MEDICAID ENCOUNTER REPORTING > > > Then why does the ruling use the word encounter data throughout the > document. > > -----Original Message----- > From: Jan Root [ <mailto:[EMAIL PROTECTED]>] > Sent: Friday, January 11, 2002 3:14 PM > To: [EMAIL PROTECTED] > 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. > > > > ********************************************************************** > 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. > > Karen Weber > [EMAIL PROTECTED] > 602-430-5612 > Fax 916-231-3387 > > > ********************************************************************** > 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.
