Responding to the 837 Claim with a 277 is not an unsolicited
response. The 277 is the appropriate HIPAA document to respond with initial
Claim Status of Claim Acceptance or Rejection to the Claim Submission.
Why would HIPAA want to perpetuate the practice of Claim Submission
Accept/Reject response from Payors in a multiplicity of proprietary
formats/code sets to the HIPAA IG 837 Claim submission?
Or, does HIPAA expect Providers to immediately map 837 Claims to a
276 Claim Inquiry, and submit the 276 right behind the 837, to force the
Payor to Respond in the HIPAA IG 277 to determine Claim Acceptance? Thus,
doubling the transaction volume for both Payor and Provider.
Did HIPAA just completely missed the boat here or what?
Thanks,
Tim Muehlberg
Texas Health Resources
EDI Technologies Implementation/Support
Phone (817) 462-6560
Fax (817) 462-2506
Email: [EMAIL PROTECTED]
-----Original Message-----
From: Rachel Foerster [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, June 26, 2002 7:03 PM
To: [EMAIL PROTECTED]
Subject: RE: an inquiry for a non-existing member
Joe,
I would agree that it would be good customer relations to send the
unsolicited 277....this, of course, would have to be in agreement with the
customer that they are able to receive such a 277.
The original question was whether it was mandatory under HIPAA to return a
271 to a 270 and a 277 to a 276. And I answered in the affirmative. HIPAA
requires that a 270 and 276 be responded to appropriately. The unsolicited
277 is not a HIPAA transaction, and as such, is neither prohibited nor
required by HIPAA.
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: Barton, Joe [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, June 26, 2002 6:49 PM
To: '[EMAIL PROTECTED]'
Subject: RE: an inquiry for a non-existing member
It may good customer relations practice to send an unsolicited 277 whenever
a claim is submitted. We do not have adjudication, once we receive a claim,
and valid, it is sent off for payment. An unsolicited 277 from us would let
our partners know either it passed edits, and is off to be processed for
payment (1-2 days) or if there was something wrong with the transaction.
-----Original Message-----
From: Rachel Foerster [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, June 26, 2002 4:35 PM
To: [EMAIL PROTECTED]
Subject: RE: an inquiry for a non-existing member
Dave,
The rationale is irrelevant. HIPAA requires that a 271 be returned in
response to the 270, and a 277 in response to a 276.
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: David Frenkel [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, June 26, 2002 10:48 AM
To: [EMAIL PROTECTED]
Subject: RE: an inquiry for a non-existing member
Alex,
I don't think you can rely on a provider to correctly enter membership
information correct 100% of the time. If you do not respond they may
not know that information was entered incorrectly and possibly delay
treatment.
It is also not of unheard of that a membership system is not up to date.
What rational would you have not to respond?
Regards,
David Frenkel
Business Development
GEFEG USA
Global Leader in Ecommerce Tools
www.gefeg.com
425-260-5030
-----Original Message-----
From: Alex Chernyak [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, June 25, 2002 8:25 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: RE: an inquiry for a non-existing member
Rachel,
Is it mandatory to respond (271 or 277) when a member is not found
on the membership system? Like status code 33 for 277 - subscriber &
subscriber id not found.... thanks
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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,
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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
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