My opinions are in the text.
Cecil L. Bohannan, Jr.
Principal Consultant
Keane, Inc.
<[EMAIL PROTECTED]>
06/06/2002 01:36 PM MST
To: <[EMAIL PROTECTED]>
cc:
bcc:
Subject: X12 278 - DDE Questions
We are a business associate and currently offer a DDE online application for Health Care Services Review Request & Response (278). Since we are a BA on behalf of our clients in which are CEs we are rewriting the application to be compliant with the 278 data content and conditions. I have several questions that are not addressed in the HHS FAQ's or WEDI White Paper on DDE. I am hoping some of you can help steer me in the right direction.
- 1. We currently have a provider update page that we offer to the health care providers using our application. Once the provider is selected they can review their demographics and update if appropriate. Are we compliant if we continue to provide this but only let them update the standard data content under Loop2010E Service Provider? Or can we direct them through a link to another application to review and update their data?
- While you may use this information to form your 278, the TCS rules do not define provider information updates as a standard transaction. There is no need to change this part of your DDE system unless you don't collect all of the required data.
- 2. We have several disclaimers and instructions listed throughout the application. Are disclaimers allowed? Or is this considered non-standard data content?
- Disclaimers are not data content. I think that they would be allowed.
- 3. How do you handle the response on a DDE application? Can you return limited data in the appropriate order? Or must you return all the required data that has been entered along with the required response data?
- The response to the provider should mimic the data of the outbound 278. As for the form of the response, you should be able to be reasonable--perhaps linking the provider to the original data?
- 4. Our application will take the provider into the medical criteria. They will be asked a series of clinical questions to complete the precertification process. Are we allowed to do this as long as we have the users answer the criteria after the appropriate code or service has been entered (i.e. following content and order of the 278)?
You should be able to use any format to obtain the standard information set.
Thank you,
Lisa
Lisa La Mont
Project Manager, IS/IT & HIPAA
Beech Street Corporation
25500 Commercentre
Lake Forest, CA92630
(949) 672-1703
Fax: (949) 450-4164
Visit Our Website:http://www.beechstreet.com
[IMAGE]
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