Robbi, Here is my understanding. The receiver needs to be able to accept HIPAA compliant transactions. So you need to be able to receive transactions with both CPT and HCPCS codes. You also need to be able to accept dialysis transactions involving EPO and having the Patient Weight. Even if you do not use the Patient Weight in your processing. If you don't use it, that is not a reason to reject the transaction. After accepting the transaction, whether you use the Patient Weight or not is your business decision.
But, let's say that you get a transaction with the Patient Weight in it, and your translator discards the Patient Weight. Later, in adjudicating the transaction you find that you need the patient weight. At that point, since the original claim already had it, you should not go back to the provider asking for the patient weight. Perhaps instead of just discarding what you don't need you should store it somewhere. As far as your validating your trading partners transactions for compliance and rejecting transactions because they are "not compliant" in an area that is not of interest to you... I still can't find where in the Final Rule it says that you need to do that. There is an HHS FAQ that seems to indicate that you are not allowed to receive and process a non-compliant transaction, but I don't think that it was HHS' intention to put all the burden of compliance on the receiver of the transaction. Other opinions? Kepa On Tuesday 25 June 2002 12:22 pm, Robbi McClane wrote: > There have been similar individual questions posted on various mail lists which are related and beg the bigger question in regards to compliance of INBOUND transactions.. > > Is the RECEIVER of an HIPAA transaction OBLIGATED to perform all levels of validations - beyond X12 and HIPAA syntax in order to be considered in COMPLIANCE? Specifically, in regards to two areas: > > 1) external code sets - both medical and non-medical (e.g. postal codes, HIN numbers, etc.) > and > 2) product or service specific (e.g. Patient Weight is required on claims invoking EPO for patients on dialysis) > > My personal interpretation of is that I must be able to RECEIVE and PROCESS codes from the external code sets - which is not necessarily the same as validating - for example, as long as my adjudication system can accept a code but doesn't utilize and therefore doesn't kick it out if it is incorrect that I am okay... - but I'm not sure if the same logic can apply to #2 (e.g. I don't require patient weight...) > > any thoughts? differences of opinion?? ********************************************************************** 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.
