Leah, I believe we're both saying the same thing and drawing the same conclusion, to wit: here's what I said in my earlier message:
"My interpretation of this is that if a health plan currently offers real time (interactive) query/response or DDE query/response TODAY, that the current response time (level of service) under HIPAA must be equal to today's response time before HIPAA. Thus, DHHS views real time and DDE as distinct modes." Rachel Rachel Foerster Rachel Foerster & Associates, Ltd. Phone: 847-872-8070 -----Original Message----- From: Leah Hole-Curry [mailto:[EMAIL PROTECTED]] Sent: Tuesday, March 26, 2002 4:10 PM To: [EMAIL PROTECTED] Subject: Clearinghouse use of html and DDE Wes, I agree with your assessment that a clearinghouse can accept computer to computer html from a provider and send it to a payer using a propietary or html format, as long as the clearinghouse "for at least one microsecond" converted the transaction into the standard. The FAQ of 8/27/00 by HHS goes through the regulatory provisions that allow this, and reaches the same conclusion. I also agree with your assessment that this appears to be a pretty short-sighted compliance strategy (but may work well as an interim solution). Note, that while the regulation prohibits the health plan from passing on its costs to the provider, in the case described, the clearinghouse acts as a provider business associate (presumably with fees attached) and then as the payer's business associate (presumably with fees attached), so there will be a charge by the clearinghouse to each party for each transaction (and responses). As you pointed out, DDE is not a clearinghouse issue because because a clearinghouse can use non-standard communications with its business associates and DDE is defined as a provider directly accessing a payer's system. If there is an intermediary, it is not with the direct data entry exception. I also suspect that if there is wide-spread use of this "loop-hole" over a continuing time period, HHS will close it. Otherwise, they won't have successfully mandated use of the standards. Kris and Rachel - I disagree that there are not clear regulatory mandates on the level of service a health plan must offer. (1) a health plan must have the capacity to electronically conduct transactions for which the secretary adopts standards 162.923 and 162.925(1). (a) some standards specify that they may be implemented in either batch or real-time. (2) 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. 162.925(2). (3) a health plan is not required to, but can also choose to continue to support non-standard communications: these include paper, person to person telephone, interactice voice response, fax back, and DDE. The DDE exception is in the reg. at 162.923(b) and the other modes are clearly not electronic media, or have been deemed by HHS (through FAQ) as modes of communication not subject to the standard. So, the electronic, standard transaction method must be supported by a health plan(or its' business associate) and it must be equal to or better than any other optional method the health plan chooses to support (paper, fax-back, DDE, etc). Otherwise, the health plan is violating the mandate that it not delay or adversely affect the transaction. (or offer incentive if DDE is at issue). In the situation below, if a health plan offers DDE which gives a provider real-time responses, it must, also offer EDI in real-time. While I agree that it would be great for HHS to list out some common "how this applies in this situation" examples for health plans, I disagree that the regulations don't already contain a mandate to have an EDI capacity that at least equals any other communication mode. Leah Hole-Curry Fox Systems, Inc. 602-708-1045 >>> [EMAIL PROTECTED] 03/26/02 08:20 AM >>> Rishel, If I am reading between the lines in your communication - you have made the statement that if we are doing DDE we must also do REAL-TIME x-12. Last I understood this was still up for debate - I understood that yes, we must offer x-12 transactions, but not necessarily "real-time" - this centered on the discussion about what an incentive is. Has there been clarification from HHS on this? Peter Berry in his white paper on DDE transactions poses the question to HHS, but I was not aware of a response. Kris Owens Senior Project Manager - HIPAA Project Presbyterian Healthcare Services 505/923-8108 [EMAIL PROTECTED] HIPAA means a higher level of healthcare. -----Original Message----- From: Rishel,Wes [mailto:[EMAIL PROTECTED]] Sent: Monday, March 25, 2002 10:35 PM To: [EMAIL PROTECTED] Subject: Computer-to-computer HTML under the transaction regulation A not uncommon way of sending "real-time" transactions today computer-to-computer is to have the sending computer send HTML to a health plan's web server, simulating what would have come from a person using a Web browser to access the health plan's Web server. This is not acceptable under the transaction regulation. However, what happens if the Web server is being run by a clearinghouse, which is converting the input to X12 and sending it to the payer? I think that MedUnite does a bunch of this, among other clearinghouses. It appears that that would be legal, right? This would not be legal under the DDE exception, which seemingly applies only to provider-payer interactions, but it would be legal under the general definition of a clearinghouse which can accept data in any old format that it wants and then convert it to the mandated format. What about the reverse? Can a clearinghouse accept standard X12 transactions and deliver them to a health plan using HTML? I think that the answer once again is yes, because a clearinghouse can accept a standard format and deliver it in whatever format it wants. So then, what happens if the clearinghouse converts the machine-to-machine HTML to X12 "for one microsecond" and then converts the X12 back to HTML and forwards it to the payer's web server. This appears to be legal, so long as the DDE web screens in use are fully the equivalent of the X12 transactions. This appears to be a loophole that would permit providers who have been sending "pseudo EDI" machine-to-machine in this manner to continue to do so. One might ask, "why would anyone want to do it this way when it would be more efficient and robust to use X12?" Indeed, the main incentive to do this goes away when health plans start offering "real time" X12 transactions, which they must if they want to continue to offer DDE. The only reason that I can think of is that where providers are already sending transactions this way it would be easier in the short term to modify the code to match a fully compliant DDE Web Server than to buy, configure, and debug a software mapper. Very short-sighted, but the question does come up. ********************************************************************** 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. --- PRESBYTERIAN HEALTHCARE SERVICES DISCLAIMER --- This message originates from Presbyterian Healthcare Services or one of its affiliated organizations. 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