It's a combination of issues. HIPAA doesn't cover completion of paper claims. There
is not a 1-on-1 correlation between the data reported on paper claims and that
required on an 837. The 835 was designed to complement the 837, not the paper claim
formats in use.
It's a big issue for some because the 835 requires reporting of some data that may not
be present on the paper claim, in which case, either the submitter needs to be
contacted to obtain that data, a search needs to be done of in-house records to see if
the data is otherwise available in house, or some sort of "gap filling" needs to be
done to enter some innocuous data in those required data elements so the 835 will be
accepted by the receiver's translator.
>>> [EMAIL PROTECTED] 09/16/02 03:32PM >>>
Last week I sent a couple questions my state Wedi group was struggling
with, and received many responses (thanks a bunch.)
The concensus on the 835 is that if a provider requests it, even if
they send a paper claim, the payer just respond with an electronic 835.
My follow-up question would be:
I have seen payers respond that they are able to return a HIPAA
compliant 835 without regard as to how the claim was received. Yet
others are saying this is going to be a big issue. Can anyone provide an
explanation as to why the variation? Is it truly a HIPAA issue, or more
of a payer specfic system issue?
Thanks!
Mimi Hart ӿ�*
Research Analyst, HIPAA
Iowa Health System
319-369-7767 (phone)
319-369-8365 (fax)
319-490-0637 (pager)
[EMAIL PROTECTED]
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