Laurie, I would very much like to see the mock-up when available. Please add me to your list.
Thanks. Jim Kelly TPA Computer Corp. ----- Original Message ----- From: "LAURIE VALENTINE" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Tuesday, October 15, 2002 1:12 PM Subject: RE: Missing Elements on an HCFA 1500 > Hi - I wanted to add this info to the conversation. I had written to > ask if they are "re-doing" the "HCFA 1500" manual claim form so that we > wouldn't have to "start from scratch" on our current local manual form. > > > > The NUCC is beginning the process of redesigning the form. By beginning > I mean that they are currently doing a crosswalk to identify the gaps > and will probably have the first mock up in November. They do plan to do > a manual with this revision and will begin working on that after they > determine the format. Once they are satisfied with the draft they will > send it out for review. Do you want me to submit your name to receive > the review document? > > Sue A Thompson > 350 Capitol Street, Room 251 > Charleston WV 25304-3709 > Phone: 304-558-1752 > Fax: 304-558-4397 > [EMAIL PROTECTED] > > Thanks, > Laurie Valentine > Venturi Technology Partners > CA Alcohol & Drug Programs > 916-327-6373 cell 775-720-3789 > > >>> "LAURIE VALENTINE" <[EMAIL PROTECTED]> 08/22/02 07:50PM > >>> > Hi - Can you tell me who, or what group, is working on revising the > HCFA > 1500 to be "semi-HIPAA compliant"? Any info or direction would be > helpful. We use a "local form" now and are thinking it may be easier > to > switch once to a form that is already out there. > > Thanks, > Laurie Valentine > Venturi Technology Partners > CA Alcohol & Drug Programs > 916-327-6373 cell 775-720-3789 > > >>> [EMAIL PROTECTED] 10/15/02 05:19AM >>> > Hi Kepa, > Can you tell me what the UB92s don't have that are required for HIPAA > compliant EDI? > > Thanks for your help! > Kevin McKiernan > CIGNA Corporate Audit > S237 > Phone: 860-226-2783 > Fax: 860-226-6450 > > CONFIDENTIALITY NOTICE: If you have received this e-mail in error, > please > immediately notify the sender by e-mail at the address shown. This > e-mail > transmission may contain confidential information. This information > is > intended only for the use of the individual(s) or entity to whom it is > intended even if addressed incorrectly. Please delete it from your > files if > you are not the intended recipient. Thank you for your compliance. > Copyright (c) 2002 CIGNA > > > > > -----Original Message----- > > From: Kepa Zubeldia [SMTP:[EMAIL PROTECTED]] > > Sent: Monday, October 14, 2002 11:41 PM > > To: [EMAIL PROTECTED]; Marcallee Jackson > > Cc: 'Anne Romer' > > Subject: Re: Missing Elements on an HCFA 1500 > > > > This is one of the reasons why it is not enough for a provider to > upgrade > > to a > > software version that is "HIPAA compliant", or to use a clearinghouse > that > > is > > compliant. Unless the provider in question implements remediations > steps > > that include capturing the necessary data, that provider will still > not be > > > > compliant even if they are using the latest software or > clearinghouse. > > > > Remember, HIPAA EDI is not just about EDI format but mostly about the > data > > > > content in those EDI transactions. And the paper 1500 or UB92 claims > do > > not > > have everything that the EDI transactions need. > > > > Kepa > > > > > > On Monday 14 October 2002 10:53 am, Marcallee Jackson wrote: > > > Anthony- > > > > > > I think the point of HIPAA is to move everyone to electronic > > > transactions using the HIPAA 837. That's the "give". Providers > are > > > expected to remediate systems and processes in order to collect > the > > > required data and produce a fully compliant electronic claim file. > The > > > intention is to move away from paper claims and to electronic > claims. > > > If providers are sending paper claims, the standard does not apply > so > > > the data elements that are a challenge in the 837 do not need to > exist > > > on the paper 1500. If you send electronic claims, you include all > data. > > > If you send paper, you send only the data required on the HCFA/CMS > 1500 > > > form. Presumably since the data does not exist on a paper claim > today, > > > it is not actually required for adjudication. The requirements of > the > > > 837 were not developed with translation from a 1500 to the 837 in > mind. > > > > > > > > > That's the rub. The data you mention is likely not required for > claims > > > payment. Just for HIPAA compliance. Which goes back to my > statement > > > that it is the provider who needs to decide the extent to which > they > > > wish to be compliant and the acceptable level of risk. A payer > could > > > tell you that they do not require this data for adjudication and > that > > > they would accept an electronic claim that was missing this > information > > > or that contained dummy data, but it is up to the provider to > decide > > > whether they are comfortable with this approach and the risk > involved in > > > it. > > > > > > Bottom line, to be fully HIPAA compliant, providers must populate > the > > > 837 claim with fully compliant data. This is true regardless of > which > > > payer you send to electronically. I don't know that I've answered > your > > > question. I have had many conversations with payers about these > data > > > elements in particular and am happy to have further discussion with > you > > > offline if you would like. > > > > > > Marcallee Jackson > > > Long Beach, CA > > > 562-438-6613 > > > > > > > > > -----Original Message----- > > > From: Anthony Mercaldi [mailto:[EMAIL PROTECTED]] > > > Sent: Monday, October 14, 2002 7:40 AM > > > To: [EMAIL PROTECTED] > > > Cc: 'Anne Romer' > > > Subject: Re: Missing Elements on an HCFA 1500 > > > > > > Hi Everyone, > > > > > > I would believe that any fields that can not be collected from a > HCFA > > > 1500, > > > should be sorted out from the 837 HIPAA IG, and reviewed. How can > my > > > providers submit data they don't have. So either these fields have > to be > > > reviewed, and a new form has to be created, or HIPAA is going to > have to > > > change the dataset(min required). This seems like the only logical > > > remedy to > > > me. What do you think about this, and can someone in the group get > the > > > response about the missing data to HIPAA? > > > Either we are going to start collecting this data, or HIPAA must > change. > > > Someone has to give! > > > > > > Thanks > > > Anthony Mercaldi > > > CTO > > > Innovative Computer Technologies, LLC. > > > > > > ----- Original Message ----- > > > From: "Marcallee Jackson" <[EMAIL PROTECTED]> > > > To: <[EMAIL PROTECTED]> > > > Cc: "'Anne Romer'" <[EMAIL PROTECTED]> > > > Sent: Sunday, October 13, 2002 2:34 PM > > > Subject: RE: Missing Elements on an HCFA 1500 > > > > > > > > > > I don't know that the question should be "How are health plans > > > > accommodating the required 837 Professional elements that can not > be > > > > obtained from a paper claim?", but rather "What are providers, > their > > > > vendors and their clearinghouses doing to fill the gap between > data > > > > available today and that required under HIPAA?". The > requirements for > > > > compliance are defined by HIPAA's implementation guide, not by > the > > > > payer. A payer could tell a provider that they do not require > any of > > > > the data you mention below (and many will) but that does not mean > the > > > > provider is compliant. Also, the issue may not just be format. > A > > > data > > > > gap can exists not only in the HCFA but also the NSF and even in > an > > > 837 > > > > since the data must be collected and stored in a system in order > to be > > > > populated in a claim. In some cases, even though an 837 claim > format > > > > can be produced, the required data elements don't exist. > > > > > > > > Clearinghouses and payers are working closely to try and find a > work > > > > around to the kinds of elements you have mentioned here. Some > of > > > those > > > > solutions will result in a fully compliant claim and some will > not. > > > In > > > > some cases it would appear the payers and clearinghouses have > weighed > > > > the cost of compliance and decided the cost to comply outweighs > the > > > risk > > > > of non-compliance. The question providers should be asking > themselves > > > > is whether or not they agree and want to take on that risk. > Providers > > > > should not simply hand over their compliance to a clearinghouse > or > > > > payer. They should take an active role in determining what > compliance > > > > will mean for them and what risks they are willing to take. > > > > > > > > One comment on the data you mention below, the HCFA 1500 allows > either > > > > an LMP or a date of illness. A single field is used for this > > > > information and no indicator exists to differentiate one type of > date > > > > from another so unless a clearinghouse can find another way to > > > determine > > > > which is which, it may not map the date correctly. Also, what > about > > > the > > > > pregnant women who is diagnosed with gestational diabetes? In > that > > > > case both an LMP and a date of illness is required and cannot be > > > > accommodated on a HCFA. > > > > > > > > No simple answers. Providers need to do their own gap analysis > and, > > > > working with their clearinghouse, vendors and payers, come up > with > > > > solutions they are comfortable with. They should not allow > another > > > > entity to determine the acceptable level of risk. Some > clearinghouses > > > > are offering gap analysis services where they compare the actual > claim > > > > data sent today with the data required in the same claim post > HIPAA. > > > > This would save the provider a lot of time and allow it to look > at > > > only > > > > the data gaps that impact its claims. Providers should be > asking > > > their > > > > clearinghouse how it plans to assist with this. > > > > > > > > Don't know if that helps but I hope in generates more > discussion. > > > > > > > > Marcallee Jackson > > > > Long Beach, CA > > > > 562-438-6613 > > > > > > > > -----Original Message----- > > > > From: Art Schenkman [mailto:[EMAIL PROTECTED]] > > > > Sent: Friday, October 11, 2002 1:49 PM > > > > To: '[EMAIL PROTECTED]' > > > > Cc: Anne Romer > > > > Subject: Missing Elements on an HCFA 1500 > > > > > > > > How are health plans accommodating the required 837 Professional > > > > elements > > > > that can not be obtained from a paper claim? > > > > ambulance services, spinal manipulation, pregnancy > > > > > > > > For example, > > > > > > > > If a chiropractor does a spinal manipulation, we would expect him > to > > > > submit > > > > his bill on a HCFA 1500 claim form > > > > > > > > For spinal manipulation, there are several required fields within > the > > > > 837. > > > > > > > > Within the 2300 loop CR2 detail (Spinal Manipulation Service > > > > Information), > > > > > > > > the following information is required and can not be found on > a > > > paper > > > > claim: > > > > Treatment Series Number, Treatment Count, Subluxation > Level > > > > Code, > > > > Treatment Period Count > > > > Monthly Treatment Count, Patient Condition Code, > Complication > > > > Indicator > > > > > > > > For ambulance transports, loop 2300 detail CR1 (Ambulance > > > > Certification), > > > > required and not on a paper claim > > > > > > > > Ambulance Transport Code, Ambulance Transport Reason Code. > > > > > > > > For obstetrical claims, the paper claim provides the last > menstrual > > > > cycle > > > > date but not the estimated date of birth. > > > > > > > > We are required to include this information when we submit the > 837 to > > > > our > > > > state agency. > > > > > > > > Has anyone addressed and or resolved an issue similar to this? > > > > > > > > NOTE: This is a re-send of two earlier emails that have > experienced > > > > receipt > > > > problems. 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