Robert,
I'd be very interested in the
e-mail from Stanley - it would be contrary to the way we currently do
business. How can we properly adjudicate a claim that requires supporting
documentation - without that documentation? That doesn't make sense to me
unless we are wrapped around the term "adjudication". We can take the
claim into our system and put a "pend" on it waiting for documentation.
Would that be considered adjudication?
I went back to the regulations and
in the comments page 50316 #4 Conducting the Transactions , Question #2, the
response says:
"We interpret this provision to mean that there should be
no degradation in the transmission of, receipt of, processing of, and response
to a standard transaction solely because the
transaction is a standard transaction....in the same time frame in which they
processed transactions prior to implementation of HIPAA."
We currently
receive claims that require supporting documentation which we take into our
system and pend waiting for the documentation to show up. I
don't perceive from my reading of the regulations that this will have to
change... this would be the same time frame as prior to HIPAA, and it is not due
to the claim being in a standard format.
I'm not yet convinced that we can't hold, i.e., pend a claim (COB or otherwise) to wait for the supporting paper documentation. Please help me to understand where my interpretation is missing the point.
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 10:40 AM
To: [EMAIL PROTECTED]
Subject:
RE: Secondary Paper Claims and EOB
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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