Sherri, It seems clearinghouse will have to convert non-standard provider transactions to standard format and then change it to the plan's proprietary format.
This is answered in one of the Q/A labeled "Parties to transaction use same clearinghouse " on the HHS site. I have included part of the answer here. You can check the full answer on http://aspe.hhs.gov/admnsimp/. Question: If a clearinghouse performs a transaction on behalf of two parties to the same transaction, how must it communicate with each party, and at what point must the transaction be in the standard? For example, a provider contracts with a clearinghouse to send transactions to a health plan on its behalf. Health Plan A contacts with that same clearinghouse to receive transmissions from provider on the health plan's behalf. The clearinghouse receives a claim from the provider in non-standard format for submission to Health Plan A. The clearinghouse's agreement with Health Plan A requires the clearinghouse to send claims to Health Plan A in another non-standard format. Must the clearinghouse translate the provider's non-standard transmission to standard format before converting it to the non-standard format required by Health Plan A? Answer: Section 162.923(a) requires a covered entity to conduct..................The inescapable result of this logic is that a clearinghouse must use a standard transaction as an intermediate stage (even if only for a microsecond) when it serves both a health care provider and a health plan conducting a transaction using non-standard formats. Sujay >>> [EMAIL PROTECTED] 04/09/02 02:24PM >>> The following reference was made in the WEDI SNIP paper titled Clearinghouse Transactions and Connectivity, Page 16. Does anyone know if there has been any response from HHS and what that response was? Thank you! [The SNIP Business Issues sub-group is submitting this point for a formal and final response as a question to HHS as follows: If a clearinghouse is under contract to both a provider and a health plan, and currently receives transactions from the provider in its proprietary format and translates them to the plan's proprietary format, do the HIPAA regulations require that this process change? Would the clearinghouse be required under the regulations to convert non-standard provider transactions to standard format before then changing them to the plan's proprietary format, adding a seemingly unnecessary step to the current process?] ********************************************************************** 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. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. ********************************************************************** 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. =====================================================The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
