Mimi, Being one myself who can get tremendiously frustrated by the inconsistencies in HIPAA EDI, I can feel your frustration. My explanation is that HIPAA wanted to accomodate everybody, even nitwits who don't know the gender of their members or patients. Or it could be transsexuals where a definitve sex assignment can be interpreted as infringements of civil right. Anyway, you could compensate for this by automatically rejecting a claim without sex code and send out an 276 requesting more information. You can also stipulate in trading partner agreements that for proper payments a valid sex code is required. Remember, you do not prevent the processing of the claim, it is just that you cannot adjudicate it without this information. This way you do accept the "U" code, but also maintain your business rules that require an "M" or "F" value.
Martin Scholl Scholl Consulting Group, Inc. 301-924-5537 Tel 301-570-0139 Fax [EMAIL PROTECTED] www.SchollConsulting.com ----- Original Message ----- From: "Mimi Hart" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, June 06, 2002 9:13 AM Subject: Re: Trading Partner/code values question > this is what is so incredibly frustrating...I want to see a "serving > suggestion" and what it means for my system...do you have an example? > MIMI > > Mimi Hart > Research Analyst, HIPAA > Iowa Health System > 319-369-7767 (phone) > 319-369-8365 (fax) > 319-490-0637 (pager) > [EMAIL PROTECTED] > > >>> Martin Scholl <[EMAIL PROTECTED]> 06/05/02 07:49PM >>> > "U" is allowed. see IG 837P, page 116 > Martin > > ----- Original Message ----- > From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]> > To: "Hope Furtado" <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]> > Sent: Wednesday, June 05, 2002 6:23 PM > Subject: RE: Trading Partner/code values question > > > > Hope, > > It's very possible that I'm confused on this, but your example > appears to > > be one of what is *not* permitted. I.e., if "U" is part of the > standard > > codeset, then it would have to be accepted. I was under the > impression > > that a "companion guide" or "TPA" could list the codes normally used > (as a > > kind of "serving suggestion") but could not require *only* that > subset be > > used, rejecting transactions that contained other valid codes... such > as > > the "U" in your example. > > > > Regards, > > Chris > > > > At 08:48 AM 6/4/02 -0400, Hope Furtado wrote: > > >A simple example would be Sex Code which under HIPAA allows for the > > >following codes: > > > > > > M - for Male > > > F - for Female > > > U - for Unknown > > > > > >A Payor or Provider cannot require that an organization only send > "F" or > > >"M", thus not accepting "U" based on an agreement outside the > standards > of > > >HIPAA. > > > > > >Please feel free to contact me if you still have any questions or > concerns. > > > > > >Hope > > > > > >Hope Furtado > > >Corporate Information Architect > > >TM Floyd & Company, Inc. > > >[EMAIL PROTECTED] > > >(800)780-1170 extension 129 > > > > > > > -----Original Message----- > > > > From: Mimi Hart [SMTP:[EMAIL PROTECTED]] > > > > Sent: Monday, June 03, 2002 4:24 PM > > > > To: [EMAIL PROTECTED] > > > > Subject: Trading Partner/code values question > > > > > > > > I apologize up front if this is the wrong set to send this > question > to: > > > > > > > > I have read and reread the Wedi Trading Partner White Paper and I > am > > > > still struggling with the following: > > > > > > > > "informational subsets of valid code values that are used in any > of > the > > > > receiver's systems or business processes" are okay... > > > > > > > > but > > > > > > > > "explicit requirements to only submit certain code values which > are a > > > > subset of the values permitted in the IGs" are not... > > > > > > > > can someone help me get this straight? another example perhaps? > Thanks > > > > MIMI > > > > > > > > Mimi Hart > > > > Research Analyst, HIPAA > > > > Iowa Health System > > > > 319-369-7767 (phone) > > > > 319-369-8365 (fax) > > > > 319-490-0637 (pager) > > > > [EMAIL PROTECTED] > > > > Christopher J. Feahr, OD > > http://visiondatastandard.org > > [EMAIL PROTECTED] > > Cell/Pager: 707-529-2268 > > >
