In order to
understand what is and is not a HIPAA transaction, you have to become very
literal. Read the Electronic Transactions and Code Sets (ETCS) rule very
carefully and quite literally. In the case of the 278 transaction it is
the provider's request for a referral or authorization
of services and the payer's or UM organization's
response to that request that is the mandated
transaction. There are additional uses of the 278 such as a notification
by a UM organization that it sends to the payer that are NOT part of the mandate
of HIPAA. While it makes a great deal of sense to use a standard
transaction where ever one exists, it is only the nine (11 if you count the 837
as three transactions) specific transactions that are detailed in the ETCS
rule that are mandatory.
One must
become very literal at times when determining what parts of e-commerce fit the
HIPAA mandates. Hope this helps.
Joan
Joan Boyle
HIPAA Compliance
Manager
The TriZetto Group, Inc.
Voice: 970-627-1675
Fax: 970-627-1677
[EMAIL PROTECTED]
-----Original Message-----
From: dale pocklington [mailto:[EMAIL PROTECTED]]
Sent: Monday, March 25, 2002 6:48 PM
To: [EMAIL PROTECTED]
Subject: Re: 278 Question
If a 278 Inquiry (4010X059) is not a HIPAA transaction. Then by definition under HIPAA what is it. I thought I had started to understand transactions now I think I must be missing something. My understanding was that a transaction was the electronic exchange of information, whether payment, referral or inquiry. I guess I must be missing what the difference is, pls help me to understand.
Dale W. Pocklington, MS, MHA, CDIA, CCA
[EMAIL PROTECTED] wrote:
Doug,
The intended use of the HIPAA 278 guide (4010X094) is for request for
health care services and associated response. A separate guide, the 278
Health Care Services Review - Inquiry and Response (4010X059) enables the
requester to inquire on the status of a health care services review (is
there an authorization/referral out there for this patient). 278 Inquiry
(4010X059) is not a HIPAA transaction.
"Darlene Peterson" <[EMAIL PROTECTED]>on 03/22/2002 07:11:24
AM
Please respond to <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
cc:
Subject: Re: 278 Question
In the implementation Guide under the 2000F Service level, the UM01 element
gives you three choices AR - Admission Review (use to request admission to
a facility) we would use as a authorization request, HS - Health Services
Review (use to request for review of services related to an episode of
care) we would use as an authorization request or SC - Speciality Care
Review (use for a request for a referral to a speciality provider) we would
use as a referral. If this line is sent in correctly it should state which
the sender is requesting. This transaction is used to request and receive
a response for authorizations and referrals.
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>>> [EMAIL PROTECTED] 03/21/02 04:54PM >>>
We are now beginning work on the 278 Referral/Auth Transaction. There
seems
to be some confusion as to what this transaction is all about. Is it just
a
request for the status of a requested referral? or can you actually
request
a referral and get an authorization back in a 278? Any input would be
appreciated.
Doug Cassavar
Paramount Health Care
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