Let's see: Bob Provider refrains from testing his transactions for HIPAA compliance and sends any old slop to Mary Payer. Mary, being generous, reads "between the lines," processes the non-compliant transaction and pays the claim. Mary does this a couple of times for Bob, and never even sends back a negative 997, an 824 application advice or even an e-mail to indicate her displeasure. Bob, not knowing any better -thinking he's doing everything right 'cause the checks keep flowing - gets more brazen and throws a doozy at Mary. This time, finally, Mary is upset - so much so that she says enough is enough, and finally tells Bob off.
Now, except for the most trivial syntax "violations" - like CR/LF pairs used as segment terminators, trailing spaces, and things of that ilk - is it really wise for Mary Payer to forgo at least warning Bob that he's screwing up? Is it really fair that now she tells him to fix his stuff? - even though he may never have known what he was doing wrong up to this point? And this may be happening at the worst possible time for Bob when his volume is really up and he's depending on those payments. Or even worse, wouldn't it be really nasty of Mary to inform on Bob to the HIPAA Stasi, if he were to persist in sending the errant transactions? They're going to ask why she didn't nip this in the bud the first time it happened and fine poor old Bob for all the previous "HIPAA infractions." The only justice (East German style) here would be if the tables were turned on Mary and she were fined for all the malformed transactions she accepted from Bob in the first place! I would say Mary Payer is best off if she puts her foot down the first time she sees a non-trivial problem (i.e., an X12 syntax violation or a HIPAA inconsistency). She's under no obligation to "fix" things for Bob Provider, and is indeed better off if she takes a hard-line stance. William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Barton, Joe" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Friday, 19 April, 2002 05:30 PM Subject: RE: Compliance with x12 vs. HIPAA IG If a transaction does fail HIPAA edits, but sufficient information is available to process the transaction such as a claim, can we still process and pay? ********************************************************************** 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.
