This whole issue is
defined in the Federal Register as I cut & pasted below. The final
rule states that repricing companies are considered covered entities under the
category of Clearinghouse. Therefore, a Covered Entity, the re-pricer,
must be HIPAA compliant with the Transaction Rule and the Privacy Rule.
Under the TC rule,
they must be able to accept standard formats and create standard formats.
Under the Privacy rule, they are subject to the Privacy Rule (fines and
penalties as well) being a Covered Entity.
There are some
situations where this would not apply, but in this situation, they get th einfo
from the provider and send it to the payer, they are defined as a Clearinghouse
and must follow all aspects of the rules.
50366 Federal Register /
Vol. 65,
"Health care
clearinghouse means a public or
private entity that does either of
the following (Entities, including but not
limited to, billing services, repricing companies, community health management information systems or community health information systems, and ‘‘value-added’’ networks and ..."
Hope this helps a
little.
Thanks - Kurt
(410) 668-1592
"This message and all attachments are confidential or proprietary
to ACS, and disclosure, use, or distribution to anyone other than the designated
recipient without the prior written permission of ACS is prohibited. If you
think you have received this message in error, please notify the sender by reply
to this e-mail and delete the message without disclosure."
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
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!
----- Original Message -----
Sent:
Wednesday, October 16, 2002 4:43 PM
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.
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.
**********************************************************************
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.
|
