Kris, I will try and provide more info later but I have a conference call
to get on shortly. The rule at 162.925 requires that a health plan may not
delay or reject a transaction, or attempt to adversely affect the other
entity or the transaction, because the transaction is a standard
transaction. I also have an e-mail from Stanley Nachimson of CMS that
clearly states the adjudication cannot be delayed awaiting the supporting
documentation. I believe there is more info in the preamble but just don't
have the time right now to search it out.
Robert C. Pozniak
NYS Department of Health
HIPAA Practice Group
One CSC Way
(518) 257-4511 fax (518) 257-4510
[EMAIL PROTECTED]
"Owens, Kris"
<[EMAIL PROTECTED]> To: "'[EMAIL PROTECTED]'"
<[EMAIL PROTECTED]>
cc:
09/17/2002 12:22 Subject: RE: Secondary Paper Claims
and EOB
PM
Please respond to
transactions
RE: Secondary Paper Claims and EOB
Robert,
I am curious about your final statement; " One thing to also note is that
when the
COB information is contained in the electronic 837 the payer may not hold
up adjudication awaiting for paper supporting documentation, i.e. paper
copies of remittance advices."
What in the regulations do you base that statement on?
thanks,
Kris Owens
505/923-8108
"Complex systems evolve from simple rules"
-----Original Message-----
From: Robert C. Pozniak [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 17, 2002 9:32 AM
To: [EMAIL PROTECTED]
Subject: Re: Secondary Paper Claims and EOB
I'd echo Kathy Simmons comments and add a couple.� Saying payers will be
ending support of paper claims and attachments may be true to the extent a
payer can attract providers willing to do nothing but electronic billing.
The electronic billing is not mandated by HIPAA with the exception of
certain size providers billing Medicare (read HR 3323).� Some providers and
their vendors may not have the ability to prepare an 837 COB
secondary/tertiary claim and therefore will be forced to file paper claims
(or the provider may need to change vendors to meet requirements of HR 3323
or other business process needs).� One thing to also note is that when the
COB information is contained in the electronic 837 the payer may not hold
up adjudication awaiting for paper supporting documentation, i.e. paper
copies of remittance advices.
Robert C. Pozniak
NYS Department of Health
HIPAA Practice Group
One CSC Way
(518) 257-4511 fax (518) 257-4510
��������������������� "Dyke, David
#
��������������������� IHTUL"������������������ To:
"'[EMAIL PROTECTED]'" <[EMAIL PROTECTED]>
��������������������� <david.dyke@ndche������� cc:
��������������������� alth.com>��������������� Subject:� Secondary Paper
Claims and EOB
��������������������� 09/17/2002 10:32
��������������������� AM
��������������������� Please respond to
��������������������� transactions
Any feedback from the community on the following comment I keep hearing
regarding Secondary paper claims:
"HIPAA will kill paper secondary claims".
The logic being that with the mandated support for COB information in the
837 4010, payers and claim processors will be ending support of paper
secondary with attached EOB, and requiring electronic submission.
Thanks
David
David Dyke, NDCHealth
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