Martin, and Marcalle, I can not commend you enough. I raised this question regarding the smaller providers, and basically was told they will have to become compliant. Well from a real world standpoint, we all know this is not like flipping on a light switch. I was also told that I should have raised these questions earlier in the development life cycle with HIPAA. It's too late now. I am struggling to find the answer to make my smaller providers become compliant. I totally agree that adjudication is much simpler than compliance. As I find solutions, or a work around, I will gladly share them with the group. I hope we all do the same.
Thanks Anthony Mercaldi ----- Original Message ----- From: "Marcallee Jackson" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, October 17, 2002 12:47 PM Subject: RE: Missing Elements on an HCFA 1500 > Martin- > > Is your statement that 90% of professional claims can be converted to an > 837 based on a fully HIPAA compliant 837 or on an adjudication compliant > version? Is that number based on a study of some kind? If so, that > information would be very helpful to the list. > > There is a difference between an 837 claim that meets adjudication > requirements and one that meets HIPAA compliance. Not hard to map a > HCFA to an 837 in order to meet adjudication requirements more difficult > to meet strict compliance. > > I am in agreement with you that providers and payers are not likely to > go through the cost of collecting new data for the sole purpose of > compliance and much of the data gap we see is not data required for > adjudication. I think your candid comments here are refreshing and that > it's time for the industry to start talking about some real world > solutions to HIPAA. As of my last conversation with Stanley Nachimson, > however, CMS/HHS sees compliance as strictly following the HIPAA IG's > regardless of the adjudication requirements. > > Marcallee > > > > -----Original Message----- > From: Martin Scholl [mailto:Martin.Scholl@;HIPAASuite.com] > Sent: Thursday, October 17, 2002 6:11 AM > To: [EMAIL PROTECTED] > Subject: RE: Missing Elements on an HCFA 1500 > > I don't have any financial interest in this vendor, so I thought by > mentioning them, I would not violate the list-serve policy but add > information. I did not provide more then a name. If I did violate the > rules, > my apologies. > > Marcallee, you talk about massive amounts of data. I think if you take > the > HCFA-1500 form for example and consider only the information that is on > it, > you are not missing that much information in order to produce a > compliant > 837P. > Let me try to list it: > Sender: Will be the clearing house or the one who is turning the HCFA > into a > 837, they know their own data. > Recipient: Field 11, or 9 in case of a secondary payer, has this > information > and an auxiliary file can map the payer to the EDI recipient. > Bill Provider: Field 33,25 plus some auxiliary data on IDs > Subscriber info: Fields 1,4,7,6 > Payer: see recipient > Patient: Fields 2,3,5,6 > Claim information:Fields 14 to 23 > Referring Provider: Field 17 with an auxiliary file on those docs > Rendering provider: Field 31 with an auxiliary file on docs within your > billing organization > Facility: Field 32 plus auxiliary information > Claim Line information: Field 24, wherby you have to determine the code > identifier, HC or NDC etc. > > The run-of-the-mill claim is not such a big problem. > In addition you have: > Accident country ---This is 99% the US and if you have the state, you > can > derive that it is in the US. And only a fraction of claims are accident > related to begin with. > > There are the Ambulance, Home Health, Oxygen Therapy, Chiropractice care > etc. claims, that you cannot create out of an HCFA-1500 without > additional > information. > > I am sure I am missing a few things. This email is not the product of > an > in-depth gap analysis, but my point is that probably 90% of professional > claims, billed through the HCFA-1500, can be converted into 837 with > reasonable effort. > Another example is a major hospital system provider whose name I will > keep a > secret. Their system is UB92 based. Even electronic claim files at this > point in time work off the print image capture file for UBs. Their > "HIPAA > compliant" database version introduces 7 new fields. That's all. > Birthweight, estimated time of birth and the others I cannot remember > off > hand. > What I want to say is that the 837 can hold massive amounts of > additional > data, but not all is required to get paid. > And I say it again. If HIPAA EDI becomes a massive stumbling block for > providers to get paid in time, because some esoteric data element is > missing > that was never required in all these years, HIPAA EDI will move to the > scrap > heap and become voluntary. No politician in their right mind will watch > the > healthcare system crumble because of a bureaucratic mess. We've seen in > December how fast Congress can vote and the president sign a law > delaying > HIPAA EDI by one year. Scrapping it in light of a national emergency > will > take less and get more cheers. > > Martin Scholl > [EMAIL PROTECTED] <mailto:Martin.Scholl@;HIPAASuite.com> > www.HIPAASuite.com <http://www.HIPAASuite.com> > 301-924-5537 Voice > 301-570-0139 Fax ********************************************************************** 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.
