RE: TPA question

[Marcallee Jackson]

Title: Message

Whether or not the TPA must be able to accept the standard, depends on whether or not the health plan has claims routed directly from the provider to the TPA or sends the TPA the claims themselves.  If the TPA is receiving claims directly from the provider on behalf of the health plan, the TPA must implement the standard and, when exchanging transactions directly with the provider, accept only the standard for that transaction.   If the TPA accepts non-standard transactions directly from the provider on behalf of the health plan, then the health plan is in violation of the final rule.    -----Original Message----- From: James Kelly [mailto:[EMAIL PROTECTED]] Sent: Wednesday, October 16, 2002 1:52 PM To: [EMAIL PROTECTED] Subject: Re: TPA question   Tamara,   Re-pricers are not covered entities under the law.  They are your business associates however.  And as such, you will have to contractually make them live up to the privacy and security provisions.   In addition, since the 837 is defined in the law as a request from a provider to a health plan for payment (or encounter reporting), this also makes the TPA (re-pricer) not required, per HIPAA,  to accept an 837.  That being said, you can always switch to a different re-pricing company who is more with the program!   Hope this helps.   Jim Kelly TPA Computer Corp.     ----- Original Message ----- From: Havenhill-Jacobs, Tamara To: [EMAIL PROTECTED] Sent: Wednesday, October 16, 2002 4:43 PM Subject: TPA question     Are TPA's who reprice claims for insurance companies required to accept the standard 837 per HIPAA guidelines?  Basically, we have a few third party administrators who believe they are exempt - and in so, require and will continue to require, additional data elements when claims are sent for re-pricing AND they do not believe they would be regarded as Business Associates.  Any feedback?   Tamara Havenhill-Jacobs HIPAA Project Lead Exempla Healthcare 303-837-6737 email:  [EMAIL PROTECTED]     ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ===================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.