Discrepancy reporting relative to benefit enrollment from a insurer back to a sponsor is not a HIPAA issue. Such reporting requirements are typically governed in the plan contract between the two entities. Whether or not said reporting is to be transacted via EDI is usually a negotiable issue between the entities. Based on my experience implementing electronic benefit enrollment with around 200 trading partners, I would say 60% of the sponsors found the insurer's own standard reports acceptable, while the remaining sponsors (mostly large employer groups) had their own demands. Since the sponsor is the one paying the premium and giving the carrier business, the sponsor usually gets their way. Of course your own reporting mileage may vary...
Sincerely, Paul Weber Past co-chair 834 work group 916-449-6970 ----- Original Message ----- From: "Wojnowski, Charlotte M." <[EMAIL PROTECTED]> Date: Wed, 10 Apr 2002 09:47:55 -0500 To: [EMAIL PROTECTED] Subject: Benefit Enrollment > What is the rule for sponsors requesting discrepency reports on benefit > enrollments? Does HIPAA have a ruling on whether the payer/insurer needs to > send back the information in the 834 format or another transaction set? If > HIPAA has no ruling on this, what is the norm for the industry? > > Charlotte Wojnowski > Caremark > 847-444-6065 > > > > ********************************************************************** > 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. > > -- _______________________________________________ Sign-up for your own FREE Personalized E-mail at Mail.com http://www.mail.com/?sr=signup ********************************************************************** 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.
