While HIPAA prohibits a plan from creating any disadvantage to the use of an adopted
implementation guide, it doesn't prohibit a plan from requesting additional
information, such as medical records, to substantiate a claim. At present, there is
no approved standard for attachments and paper attachments are allowed. I don't
recall anything in the regulation that prohibits a secondary payer from requesting any
potential form of supporting documentation.
>>> [EMAIL PROTECTED] 09/17/02 11:31AM >>>
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
[EMAIL PROTECTED]
"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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