Dave, Yes, I was aware of that FAQ and it was that issue (that both parties are out of compliance) that I was trying to identify.
I guess I was sufficiently clear. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http://www.rfa-edi.com -----Original Message----- From: David A. Feinberg, C.D.P. [mailto:[EMAIL PROTECTED]] Sent: Saturday, April 20, 2002 11:09 AM To: [EMAIL PROTECTED] Subject: Re: Compliance with x12 vs. HIPAA IG One little wrinkle from http://aspe.hhs.gov/admnsimp/q0533.htm: Question: "If a health care provider electronically conducts a non-compliant transaction (transmits an old National Standard Format or a proprietary format) directly to a health plan after the transaction regulation compliance date, and the health plan accepts and processes the non-compliant transaction, who is in violation of the regulation? Is it the health care provider or the health plan?" Answer dated 11/2/2001: "If a health care provider electronically conducts a non-standard transaction with a health plan after the transaction regulation compliance date, the health care provider and the health plan are both out of compliance. Section 162.923(a) of the rule requires a covered entity conducting an electronic transaction for which a standard has been adopted with another covered entity to conduct it as a standard transaction." Dave Feinberg Rensis Corporation 206-617-1717 [EMAIL PROTECTED] ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Friday, April 19, 2002 7:35 PM Subject: RE: Compliance with x12 vs. HIPAA IG >From a business perspective, I'd agree that Mary Payer didn't do Bob Provider a favor by not reporting the non-compliant condition. <snip> Rachel Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http://www.rfa-edi.com -----Original Message----- From: Barton, Joe [mailto:[EMAIL PROTECTED]] Sent: Friday, April 19, 2002 6:21 PM To: '[EMAIL PROTECTED]' Subject: RE: Compliance with x12 vs. HIPAA IG Said well, but anyone who does not inform the person with an 824 or 997 back is non-compliant, nor a good business practice. I remember almost 2 years ago, during a class presented by the feds, that if there are errors, but those errors will not prevent proper processing for payment by the payers payment system, that the payment shall not be delayed until the transaction is resent in it's fixed format. The sender must be notified that a non-compliancy issue exits. Mary did a no no by not sending information back to the sender of the error. Thoughts? Joe -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Friday, April 19, 2002 4:06 PM To: [EMAIL PROTECTED] Subject: Re: Compliance with x12 vs. HIPAA IG 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. 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