But they must translate standard to non-standard or non-standard to
standard transactions. This is the definition of a clearinghouse in HIPAA.
You must read further in the definition. The re-pricer is not a
clearinghouse if it does neither of these.
Thank you,
Terry Christensen
[ IS Administration Simplification EDI
Telelphone: (402)351-6370
Fax: (402)351-8025
e-mail: [EMAIL PROTECTED]
"Kurt Hartmann"
<kurt.hartmann@ac To: [EMAIL PROTECTED]
s-inc.com> cc:
Subject: RE: TPA question
10/17/2002 08:04
AM
Please respond to
transactions
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
[EMAIL PROTECTED]
"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."
-----Original Message-----
From: Marcallee Jackson [mailto:marcallee@;msn.com]
Sent: Wednesday, October 16, 2002 8:11 PM
To: [EMAIL PROTECTED]
Subject: RE: TPA question
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:JKelly@;tpacomputer.com]
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.
**********************************************************************
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.
