I wish life (and HIPAA) were so simple. We are an integrated delivery system and so anguish over these issues for both the billing office for our hospitals, and our healthplan. HIPAA may (and we question this) help some in standardizing claims, but realize there are many segments that are situational - "required when information impacts reimbursement or to validate treatment." Some payers will need these some won't. At least under HIPAA payers can't get away with rejecting the claim for the provider supplying more information than they use - so maybe we can eventually get to a "master" claim format that is all things to all our payers, but I'm not holding my breath. Oh yea, and then there's that nasty problem of one payer wanting the service on a facility claim and another wants it on a professional.....
Kris Owens
Senior IS Project Manager - HIPAA Project
Presbyterian Healthcare Services
Albuquerque, NM
505.923.8108
[EMAIL PROTECTED]
"There is no meaning in isolation"
-----Original Message-----
From: David Frenkel [mailto:[EMAIL PROTECTED]]
Sent: Friday, May 03, 2002 1:43 PM
To: [EMAIL PROTECTED]; 'WEDi/SNIP ID & Routing'
Subject: RE: FW: Article
This is an interesting article from yesterday's AHA news.
Regards,
David Frenkel
Business Development
GEFEG USA
Global Leader in Ecommerce Tools
www.gefeg.com
425-260-5030
AHA urges HHS to require health plans to accept HIPAA claims AHA in a
letter today urged HHS Secretary Tommy Thompson to adopt a rule or
guidance requiring health plans to accept hospitals' claims compliant
with the Health Insurance Portability and Accountability Act. According
to the letter, one of the major administrative costs and sources of
frustration facing hospitals is frequent claim payment delays,
particularly by private payers. The final HIPAA regulation on electronic
formats and code sets established national standards for electronic
submission of claims, and makes clear that health plans are not
permitted to require additional elements that deviate from those
specified, the letter adds. Plans can be somewhat arbitrary in
processing, leaving providers facing payment delays and engaged in
"wasteful" resubmissions and reconciliation. The letter asks HHS to
clarify that plans must accept HIPAA-compliant claims for contractual
provisions with other entities covered under HIPAA and for state and
federal prompt pay requirements. The letter will be at
<http://www.aha.org>.
--- PRESBYTERIAN HEALTHCARE SERVICES DISCLAIMER ---
This message originates from Presbyterian Healthcare Services or one of its affiliated organizations. It contains information, which may be confidential or privileged, and is intended only for the individual or entity named above. It is prohibited for anyone else to disclose, copy, distribute or use the contents of this message. All personal messages express views solely of the sender, which are not to be attributed to Presbyterian Healthcare Services or any of its affiliated organizations, and may not be distributed without this disclaimer. If you received this message in error, please notify us immediately at [EMAIL PROTECTED]
