I think we need to be careful when we are interpreting other organizational structures and I respectfully have to disagree with you. In my orgnaization we have contracts where the clearinghouse adjudicates and pays the claim. Some payers do not adjudicate their own claims and have clearinghouses on their front end. In my opnion this company could be defined as a clearinghouse and we have to be careful when we take positions regarding stucture. If this company is scanning UB92's and HCFA 1500's to an electronic format they are translating a paper claim into an electronic format. Since the UB's and the HCFA 1500's do not as yet align with the 837, it all depends what they do whit the data after it is converted. As I said in my answer, it is wise to verify structure with both inside and external legal counsel before decideing.
> -----Original Message----- > From: Rachel Foerster [SMTP:[EMAIL PROTECTED]] > Sent: Monday, June 24, 2002 1:51 PM > To: [EMAIL PROTECTED] > Subject: RE: A Clearinghouse By Any Other Name ... > > Colleen, > > I respectfully disagree with your conclusion that they are solely > performing > a clearinghouse function. I don't believe that clearinghouses actually > adjudicate and pay a claim. Rather, this is usually a function that is > performed by the payer. If the payer then hires another company to perform > that function for them, that outside company is a business associate. A > clearinghouse under HIPAA is defined as any entity that translates > non-standard data/format into the standard or vice versus. This company is > scanning paper claims into a document imaging system and then keying the > data into an adjudication system. This company's existence and role is > totally transparent to the provider/payee. Thus, this company isn't > translating non-standard data/format into standard, but is actually > adjudicating the claim, and making payment based on the results of that > adjudication. > > This is the rationale I used when concluding that the company is a > business > associate, but not necessarily a clearinghouse. I agree that a > clearinghouse > can play both the role of a CH and a business associate, but I don't think > this company is doing so in this instance. Thus, my recommendation to seek > their own legal counsel opinion. If their legal counsel concludes they are > in effect a clearinghouse then there are much broader implications for > them > as a covered entity that if they are only a business associate of a > covered > entity. > > Rachel Foerster > Principal > Rachel Foerster & Associates, Ltd. > Professionals in EDI & Electronic Commerce > 39432 North Avenue > Beach Park, IL 60099 > Phone: 847-872-8070 > Fax: 847-872-6860 > http://www.rfa-edi.com > > > -----Original Message----- > From: Grimes, Colleen [mailto:[EMAIL PROTECTED]] > Sent: Monday, June 24, 2002 11:30 AM > To: '[EMAIL PROTECTED]' > Subject: RE: A Clearinghouse By Any Other Name ... > > > You should always check with you legal department, but what you are > describing sounds like a clearinghouse function. A clearinghouse can be a > buisness associate and a trading partner. > > Thanks, > > Colleen > > > -----Original Message----- > > From: Rachel Foerster [SMTP:[EMAIL PROTECTED]] > > Sent: Monday, June 24, 2002 11:44 AM > > To: [EMAIL PROTECTED] > > Subject: RE: A Clearinghouse By Any Other Name ... > > > > My opinion is that you are a business associate of the health plan, > which > > has outsourced this function to you to perform on their behalf. Best > > course > > of action is for you to confirm this with your company's legal counsel > AND > > the legal counsel of the health plan for which you perform these > services. > > > > Rachel Foerster > > Principal > > Rachel Foerster & Associates, Ltd. > > Professionals in EDI & Electronic Commerce > > 39432 North Avenue > > Beach Park, IL 60099 > > Phone: 847-872-8070 > > Fax: 847-872-6860 > > http://www.rfa-edi.com > > > > > > -----Original Message----- > > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] > > Sent: Monday, June 24, 2002 9:45 AM > > To: [EMAIL PROTECTED] > > Subject: A Clearinghouse By Any Other Name ... > > > > > > > > > > Would anyone here have an opinion of "what type of entity", from a > > > > HIPAA Transaction Rule perspective, the following operation could be > > > > categorized? > > > > > > > > I have an operation that receives; on behalf of a HEALTH PLAN, paper > > claims > > > > from the PLAN's health care PROVIDERS (doctors, hospitals, etc.). > > > > > > > > We then take the paper claims; scan them into an imaging system, key the > > > > claims into our own claims processing software system (off the scanned > > image > > > > of the paper claim), adjudicate the claim, cut the paper check and EOB > > > > and/or ERA and mail. > > > > > > > > The submitting providers; and the payee's on the backend have no > knowledge > > > > of us. The checks bear the logo/address/signature of our health plan > > > > clients. > > > > > > > > And the address where the paper claims are mailed have the name of our > > > > health plan clients; with a PO Box that we set up; and from which we > > collect > > > > the inbound mail. > > > > > > > > Question: does this make us a "CLEARINGHOUSE"? [I had, naively perhaps, > > > > assumed that a "HIPAA defined clearinghouse" was one that reformatted > data > > > > from a non-HIPAA standard format to a HIPAA standard format or > vice-versa; > > > > and I had assumed that the media on both sides of this are electronic - > > but, > > > > when I look at the definition below; perhaps the rule applies to "paper" > > as > > > > a 'non-HIPAA standard format' as well.]. > > > > > > > > > > > > > > > > Definition below for convenience - from the WEDI/SNIP Glossary > > > > > > > > Health Care Clearinghouse: Under HIPAA, this is an entity that processes > > or > > > > facilitates the processing of information received from another entity > in > > a > > > > nonstandard format or containing nonstandard data content into standard > > data > > > > elements or a standard transaction, or that receives a standard > > transaction > > > > from another entity and processes or facilitates the processing of that > > > > information into nonstandard format or nonstandard data content for a > > > > receiving entity. Also see Part II, 45 CFR 160.103. > > > > > > > > Henry A Perretta > > > > HAPCO International, LLC > > > > 6302 Dunman Way > > > > Alexandria,VA, 22315 > > > > > > > > > > ********************************************************************** > > To be removed from this list, send a message to: > > [EMAIL PROTECTED] > > Please note that it may take up to 72 hours to process your request. > > > > ====================================================== > > The WEDI SNIP listserv to which you are subscribed is not moderated. > The > > discussions on this listserv therefore represent the views of the > > individual > > participants, and do not necessarily represent the views of the WEDI > Board > > of Directors nor WEDI SNIP. If you wish to receive an official opinion, > > post your question to the WEDI SNIP Issues Database at > > http://snip.wedi.org/tracking/. > > Posting of advertisements or other commercial use of this listserv is > > specifically prohibited. > > > > > > > > ********************************************************************** > > To be removed from this list, send a message to: > > [EMAIL PROTECTED] > > Please note that it may take up to 72 hours to process your request. > > > > ====================================================== > > The WEDI SNIP listserv to which you are subscribed is not moderated. > The > > discussions on this listserv therefore represent the views of the > > individual participants, and do not necessarily represent the views of > the > > WEDI Board of Directors nor WEDI SNIP. If you wish to receive an > official > > opinion, post your question to the WEDI SNIP Issues Database at > > http://snip.wedi.org/tracking/. > > Posting of advertisements or other commercial use of this listserv is > > specifically prohibited. > > > > > ********************************************************************** > To be removed from this list, send a message to: > [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. > > ====================================================== > The WEDI SNIP listserv to which you are subscribed is not moderated. The > discussions on this listserv therefore represent the views of the > individual > participants, and do not necessarily represent the views of the WEDI Board > of Directors nor WEDI SNIP. If you wish to receive an official opinion, > post your question to the WEDI SNIP Issues Database at > http://snip.wedi.org/tracking/. > Posting of advertisements or other commercial use of this listserv is > specifically prohibited. > > > > ********************************************************************** > To be removed from this list, send a message to: > [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. > > ====================================================== > The WEDI SNIP listserv to which you are subscribed is not moderated. The > discussions on this listserv therefore represent the views of the > individual participants, and do not necessarily represent the views of the > WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official > opinion, post your question to the WEDI SNIP Issues Database at > http://snip.wedi.org/tracking/. > Posting of advertisements or other commercial use of this listserv is > specifically prohibited. > ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
