Thanks, I do not see how Hipaa can expect edits to be applied to a claim adjustment when the original claim was processed before the edits were established. Does Claim generation refer to the date the claim was generated by the provider, if so then claims already in our system prior to the Hipaa switch being turned on do not have to meet the Hipaa edits. Correct?
Mike Winston Business Systems Analyst Trigon ISD Ph (804) 354-4521 Fx (804) 678-0452 [EMAIL PROTECTED] This message, including files attached to it, may contain confidential information that is intended only for the use of the ADDRESSEE(S) named above. If you are not the intended recipient, you are hereby notified that any dissemination or copying of the information is strictly prohibited. If you have received this message in error, please notify the sender immediately and delete the message from your system. Thank you. > -----Original Message----- > From: Dhandapani, Palani (Cognizant) [SMTP:[EMAIL PROTECTED]] > Sent: Tuesday, May 21, 2002 10:15 AM > To: Winston, Mike K.; [EMAIL PROTECTED]; '[EMAIL PROTECTED]' > Subject: RE: Date of service > > There are two components here. Medical code sets and NonMedical code sets. > > For Non-medical code sets, the Data of service is the reference. So we > should use the medical codes that are valid on the date of service. > > For Non-medical code sets, the date of Claim generation is the reference. > > Please refer to the following regulation: > > 162.1000 > > (a) Medical data code sets: Use the applicable medical data code sets > described in section 162.1002 as specified in the implementation > specification adopted under this part that are valid at the time the > health > care is furnished. > > (b) NonMedical data code sets: Use the non medical data code sets as > described in the implementation specifications adopted under this part > that > are valid at the time the transaction is initiated. > > Hope this helps. > > Thanks > Palani > Cognizant Technology Solutions > 201-678-2772 > > > -----Original Message----- > From: Winston, Mike K. [mailto:[EMAIL PROTECTED]] > Sent: Tuesday, May 21, 2002 6:37 AM > To: [EMAIL PROTECTED]; '[EMAIL PROTECTED]' > Subject: Date of service > > > I know this was discussed, but I want to confirm that opinions have not > changed. When Hipaa is in effect we are planning on using the claims Date > of > Service to determine if the claim needs to be fully compliant or not, > example: Claim was submitted prior to Hipaa live date with a "Homegrown > code" the 835 goes out after Hipaa is implemented with the non-compliant > code. or Claims that were not subject to any crossfoot edits prior to > hipaa > if adjusted will be sent out on the 835 but will not crossfoot. > > We are making the logic based on the claims date of service not the > processed date. Any thoughts? > > Mike Winston > Business Systems Analyst > Trigon ISD > Ph (804) 354-4521 > Fx (804) 678-0452 > [EMAIL PROTECTED] > > This message, including files attached to it, may contain confidential > information that is intended only for the use of the ADDRESSEE(S) named > above. If you are not the intended recipient, you are hereby notified > that > any dissemination or copying of the information is strictly prohibited. > If > you have received this message in error, please notify the sender > immediately and delete the message from your system. Thank you. > > > > > > << File: InterScan_Disclaimer.txt >>
