Laurie,
I believe you must use valid codes both medical and non-medical in all of the covered transactions. This means all those non-medical code sets that are throughout the implementation guides.
From the regulations 162.1000 General Requirements. "When conduction a transaction covered by this part a covered entity must meet the allowing requirements: (a) Medical data code sets. Use the applicable medical data code sets described in 162.1002 as specified in the implementation specification adopted under this part that are valid at the time the health care is furnished. (b) Nonmedical data code sets. Use the nonmedical data code sets. Use the nonmedical data codes sets as described in the implementation specifications adopted under this part that are valid at the time the transaction is initiated."
So...the question that keeps popping up on the listserv, but never seems to quite get resolved, what happens when a provider sends in a paper claim with an invalid or deleted code. (We accept them into the system so that we can deny them - we don't reject paper claims up front for invalid codes like we do with electronic claims - it just is not practical to be sending paper claims back to the provider). Then the provider sends a claims status request for the claim with the invalid code and we want to tell them that we are denying the claim for using an invalid code - how do we communicate that the code is invalid without using an invalid code in the transaction?
Kris Owens
923-8108
"There is no meaning in isolation"
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]]
Sent: Tuesday, July 09, 2002 2:21 PM
To: [EMAIL PROTECTED]
Subject: 276/277 code set validation
As the HIPAA regs require that medical code sets be validated, should this
validation be extended to the 276 claim status inquiry?
Laurie Cayer
Project Management Consultant
HIPAA Implementation Team
4201 Town Center Dr.
ElDorado Hills, CA 95762
916-350-2886
mailto:[EMAIL PROTECTED]
**********************************************************************
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.
--- 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]
