Bob, I would like to ask you a couple of questions:
Is RealMed considered to be a healthcare system vendor, TPA, or something other? Do the physicians that use the RealMed Network STILL receive monies for each transaction that they process thru the RealMed Network? And is this why you are becoming disturbed by out listserv members comments about DDE? Thanks for the information. Max Bumbalough GovConnect, Inc. >From: "Robert Huffman" <[EMAIL PROTECTED]> >To: "Owens, Kris" <[EMAIL PROTECTED]>, "Stuart Beaton" <[EMAIL PROTECTED]>, >"David Frenkel" <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]> >Subject: RE: Internet Transaction limitations? >Date: Mon, 3 Jun 2002 07:33:49 -0500 > >I am getting very tired of this groups dissertation on DDE and incentive. >DDE exists today, and sometimes returns data as a response to data entered >and sometimes it is only Data Directly Entered with no response. The HIPAA >stance on DDE is that a payer cannot offer an incentive to use DDE (data >only without regard to format). Where do you people get the idea that >simply using an existing DDE can be construed to be an incentive? We have >waited several months for HHS to clarify the meaning of incentive, yet most >of you have already made up your mind and are trying to convince the rest >of us. Stop it. Wait for HHS. > >HIPAA is based upon Administrative Simplification. This discussion on what >amount of data can be returned on a complete HIPAA transaction and in what >time frame is ludicrous. DDE exists today and will exist tomorrow. Until >HHS tells us that every HIPAA transaction must be as complete and as fast >as currently existing DDE operations then get off this wagon. HHS will >clarify in time what is meant by incentive. Continuing tomorrow what we do >today is not an incentive. Money is an incentive. > >Bob Huffman >RealMed Corporation >Indianapolis, Indiana > > >-----Original Message----- >From: Owens, Kris [mailto:[EMAIL PROTECTED]] >Sent: Friday, May 31, 2002 6:25 PM >To: 'Stuart Beaton'; David Frenkel; [EMAIL PROTECTED] >Subject: RE: Internet Transaction limitations? > > > >One point of clarification - your statement "The 271 response must also be >returned as quickly as the one returned on the DDE system (once again there >cannot be an incentive to receive a faster response on DDE over the >standard transaction)." > >HHS has been asked to confirm that response time is indeed considered an >incentive. As far as I am aware of, they have not yet confirmed this. At >this point this is an interpretation of incentive, it is not implicitly >stated in the regulations. > >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: Stuart Beaton [ mailto:[EMAIL PROTECTED]] >Sent: Friday, May 31, 2002 5:02 PM >To: David Frenkel; [EMAIL PROTECTED] >Subject: RE: Internet Transaction limitations? > > >There are a few things to bear in mind about DDE, internet or not, vs >270/271 (or any mandated transaction for that matter). If the health plan >offers DDE, they must also support their 270/271 to the same level as the >DDE system, so long as there is a place for the information in the 270/271. > Not supporting the standard transaction to the same level as on DDE would >be considered an incentive to use DDE over the standard transaction. 45 CFR >Parts 160 and 162 (the transaction final rule) states: > > >"162.925(a)(4) A health plan may not offer an incentive for a health care >provider to conduct a transaction covered by this part as a transaction >described under the exception provided for in 162.923(b). > > >"162.923(b) Exception for direct data entry transactions. A health care >provider electing to use direct data entry offered by a health plan to >conduct a transaction for which a standard has been adopted under this part >must use the applicable data content and data condition requirements of the >standard when conducting the transaction. The health care provider is not >required to use the format requirements of the standard." > >For instance, if the DDE system can identify that the subscriber has a $10 >copay for a physician office visit, they must return this information in >the 271 (EB*B**98****10~). If the DDE system identifies the subscriber's >Primary Care Physician, so must the 271 >(EB*L~LS*2120~NM1*P3*1*JONES*MARCUS***MD*SV*111223333~). Most of the >information that could be displayed on a DDE system would be able to be >returned in the 271 transaction. > > >The 271 response must also be returned as quickly as the one returned on >the DDE system (once again there cannot be an incentive to receive a faster >response on DDE over the standard transaction). > > >Offering an elaborate DDE system and supporting the "Yes/No" minimal >response on the 271 mentioned below would not be a compliant solution. > > >Stuart Beaton >Vice President >Washington Publishing Company >Co-Chair X12N/TG2/WG1 - Health Care Eligibility >[EMAIL PROTECTED] > > -----Original Message----- > From: David Frenkel [ mailto:[EMAIL PROTECTED]] > Sent: Thu 5/30/2002 12:53 PM > To: [EMAIL PROTECTED] > Cc: > Subject: RE: Internet Transaction limitations? > > > > Larry, > You are correct but you might ask the healthplans you may work >with if > they can support anything beyond 'yes' or 'no' for eligibility on >the > 270/271. A yes or no response is the minimum requirement for the > 270/271. > > Regards, > > David Frenkel > Business Development > GEFEG USA > Global Leader in Ecommerce Tools > www.gefeg.com > 425-260-5030 > > -----Original Message----- > From: [EMAIL PROTECTED] [ mailto:[EMAIL PROTECTED]] > Sent: Thursday, May 30, 2002 9:22 AM > To: [EMAIL PROTECTED]; [EMAIL PROTECTED] > Subject: Re: Internet Transaction limitations? > > Is it also true, that even if a healthplan supports a DDE type of > eligibility > system that they must ALSO support a 270/271 if that transaction >is > requested > by any of their providers? > > Larry A. Saltzman, MD > > > > > >--- 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] > _________________________________________________________________ Chat with friends online, try MSN Messenger: http://messenger.msn.com
