The vision of standardization comes from the Federal Legislation.
Variations in interpretation of the IGs are inevitable, but we're moving
from 100% varation in how these transactions are done, to a much smaller
percentage (10%?) variation - that's where the ROI is.
By the way, thought I'd throw in a citation. Following is from Federal
Register: August 17, 2000 (Volume 65, Number 160)], Section 162.925
"...
(3) A health plan may not reject a standard transaction on the
basis that it contains data elements not needed or used by the health
plan (for example, coordination of benefits information)."
Apologies to this listserver for clogging it up, I thank you for tolerating
this message, this is where the conversation started so...
I'm headin' to Business Issues :^> Cynthia
----- Original Message -----
From: "Mimi Hart" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>
Sent: Saturday, March 01, 2003 11:43 AM
Subject: Re: Payers and Optional Fields
I would agree that including a field like Taxonomy Codes all the time,
should help with cross payer "standard transactions" just as you state.
However, the comment from Mark I believe is just the sort that drives
providers out of their minds. Why are we doing this work to
"standardize" if there are no standards? Where will our ROI be? Do the
people that wrote these regs believe that their vision of
standardization is out the door?
My opinion only. MIMI
Mimi Hart ӿ�*
Research Analyst, HIPAA
Iowa Health System
319-369-7767 (phone)
319-369-8365 (fax)
319-490-0637 (pager)
[EMAIL PROTECTED]
>>> "Cynthia Korman" <[EMAIL PROTECTED]> 02/28/03 05:09PM
>>>
Well, couldn't one argue that in the case of Provider Taxonomy codes
(and other situational fields that, per the IGs, are to be included if
required for claims adjudication), a cross-payer "standard transaction"
would always contain the provider taxonomy code? (and other...).
Payers that don't use the Provider Taxonomy code (and...) are prohibited
from rejecting a claim that contains it, and only those that need it
would look at it.
>From a business process perspective providers may or may not want to
take this option. (In the case of taxonomy code, my impression is that
"would not" is in some cases the definite option of choice) But if one
is focusing on having a "one size fits all" hipaa-compliant claim, there
are some areas where it's not impossible...The question, I think, is: is
there a business case, from the provider perspective, for generating a
"one size fits all" claim, and the answer to that question will vary.
TGI!F! Cy
----- Original Message -----
From: Marcus E. McCrory
To: WEDI SNIP Testing Subworkgroup List
Sent: Friday, February 28, 2003 12:15 PM
Subject: Re: Payers and Optional Fields
Miriam,
I hate to burst your bubble, but there have never been standards.
Our mindset has always been that these are guides, which in turn are
subject to interpretation.
----- Original Message -----
From: Miriam Paramore
To: WEDI SNIP Testing Subworkgroup List
Sent: Friday, February 28, 2003 7:14 AM
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
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-----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 differ
ent. 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
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other
> person is strictly prohibited.
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>
>
>
>
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