Miriam: The coinage 'optional' from a map testing perspective is NOT rellay that odd, IMHO.
For example, I'd like to say in the case of NM, if it is person, Lastname is 'required' and middlename/suffix are 'oiptional'. By this I mean some compliant transactions can have and some may not have the middlename/suffix and using the word 'optional' is one way to differentiate the test cases, while using the coinage 'situational' can differentiate at the higher level whether it is of a person or an organization. Makes sense??? I think so ;). Of course the context of this coinage is more leaning towards map testing frame of mind and less towards IGs and related coinage and I would be less hesitant to use it in my test matrices in the 'usage' column to enhance readability. Regards, --Rama. -----Original Message----- From: "Miriam Paramore" <[EMAIL PROTECTED]> Sent: Fri, 28 Feb 2003 10:14:26 -0500 To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> Subject: RE: Payers and Optional Fields Thanks to all responses. Yesterday HAWK put on a testing seminar here in Louisville. One of the providers brought up this specific example and said "the standard is not a standard". You are all correct that I incorrectly used the word optional. Bottom line, if payers can require something for adjudiation (as situational), then there is no standard across payers. Right? This makes our payer data requirements cross reference much harder (a HAWK project). Disappointed... Best Regards, Miriam J. Paramore President & CEO PCI: e-commerce for healthcare 9001 Shelbyville Road iTRC Building Louisville, KY 40222 502-429-8555 www.hipaasurvival.com ========================================== This email contains confidential information intended only for the named addressee(s). Any use, distribution, copying or disclosure by any other person is strictly prohibited. -----Original Message----- From: Kepa Zubeldia [mailto:[EMAIL PROTECTED] Sent: Friday, February 28, 2003 10:06 AM To: Miriam Paramore; WEDI SNIP Transactions Workgroup List; WEDI SNIP Testing Subworkgroup List Subject: Re: Payers and Optional Fields Miriam, The content of the transaction is under the control of the submitter as long as the submitter is complying with the implementation guide. The theory is that a payer cannot say that they will not "accept" something that is valid in the guide, or that they "require" something the guide does not require (including situational requirements). That is the HIPAA theory. The reality, at least today, is different. Will the reality change after October 16? Maybe... But as of today, a payer that has filed for the ASCA extension, or small health plans that did not need to file for the ASCA extension, do not need to be compliant with HIPAA yet, so they can superimpose their own requirements. Perhaps that will change in October. At least it "should" change. Or is it "must" change? :-) As for the Taxonomy code, if the payer says "I need the taxonomy code because it impacts my adjudication system" then the provider MUST send it because that is what the implementation guides (Addenda) now require. Kepa Zubeldia Claredi On Friday 28 February 2003 07:08 am, Miriam Paramore wrote: > This is probably the 100th time this has been asked... but bear with me. > > Can a payer mandate that a provider put a certain value in an optional > field? Unisys has stated that it is requiring the taxonomy code in an > optional field, and will not pay the claim unless that optional field is > present. > > I think this flies in the face of all things HIPAA standard. Isn't that > type of payer behavior expressly prohibited? Still, other payers felt that > they could get by with such a mandate as a "business rule" between trading > partners. Sounds like the dog is still getting wagged. > Best Regards, > > Miriam J. Paramore > President & CEO > PCI: e-commerce for healthcare > 9001 Shelbyville Road > iTRC Building > Louisville, KY 40222 > 502-429-8555 > www.hipaasurvival.com > ========================================== > This email contains confidential > information intended only for the named > addressee(s). Any use, distribution, copying or disclosure by any other > person is strictly prohibited. > > > > > > --- > 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. > > You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] > To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] > If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org > -- This email contains confidential information intended only for the named addressee(s). Any use, distribution, copying or disclosure by any other person is strictly prohibited. --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. 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