10% of our payers are production with HIPAA transactions. Out of those, we only have one that we didn't have to "tweak" to force it to non-compliance so their system could accept the file.
23% of our payers have been stringing us along testing for weeks. We get clean 997's and responses from their staff like "that's the cleanest file we have ever seen" but they aren't ready because they have too many bugs to fix in their translators. The remaining 67% of our payers have been telling us they won't be ready to test until July or August. Two have actually said to wait until October. It is shocking to me that there is this much talk about testing so late in the game. The NCVHS was advised against having ONE DEADLINE for the entire industry. Please educate me if I am wrong about this... It appears that the NCVHS is driving the HIPAA train wreck and they seem to disregard any idea contrary to what fits an agenda they have already set. What WEDI suggested to the Secretary of Health is complicated and worthless. Relaxing edits doesn't help when the payer can't even get the data in the door correctly. I have examples of this from payers that don't understand their own translator software well enough and are leaning on unresponsive vendors. The powers that author change cannot absorb and approve any new idea quick enough. It has to be a very simple idea. Many (not all) payers are using up all of the time to get ready and they are leaving very little or no time for trading partners to transition into their new EDI. The deadline should stay the same for payers and the rest of us should get another 6 (or more) months to connect. The payers should be required to parallel new and old EDI until they have provided sufficient time for all of their trading partners to migrate. Because that is unlikely, we have already made the decision that messing with the bugs in third-party certification is the lowest priority of all testing. John W. Carter Healthcare Administration Technologies, Inc. > -----Original Message----- > From: Rich MacCatherine [mailto:[EMAIL PROTECTED] > Sent: Thursday, June 12, 2003 8:00 AM > To: WEDI SNIP Testing Subworkgroup List > Subject: RE: your post on submitting clean transactions > > > As a vendor who has tested with many payers directly, I have > to agree with Jeff's assessment. While not all payers > practice this type of deviation, I've seen it enough to know > it's going to be a challenge to get it to stop. Being > compliant and getting payment are totally separate issues in > the "real world." I've certified my systems transactions so > I know I can create HIPAA compliant files, but that has > stopped the need for me to "tweak" my program to deviate from > the rules of the IG due to certain companion guides' requirements. > > __________________________________________ > __________________________________ > Richard J. MacCatherine > Business Analyst > Source Medical Solutions, Inc. > 866 North Main Street Extension > Wallingford, CT 06492 > Direct: 203.284.7582 > Fax: 203.284.7620 > Email: [EMAIL PROTECTED] > Web: www.sourcemed.net > NOTICE: This communication may contain Protected Health > Information, as defined by the Health Insurance Portability > and Accountability Act, that is privileged, confidential or > exempt from disclosure by federal or state law. If you are > not the intended recipient, please note that any > dissemination, distribution, or copying of this communication > is strictly prohibited. Anyone who receives this message in > error should notify the sender immediately by telephone or by > e-mail and return the document in its original form. Thank you. > > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] > Sent: Thursday, June 12, 2003 8:50 AM > To: WEDI SNIP Testing Subworkgroup List > Subject: Re: your post on submitting clean transactions > > Kepa, > > As a provider, I'm seeing quite the opposite of what you say > about clean > transactions, here in the real world. > > Regardless of the fact that federal regulation require a > payer to accept > a clean X12 claim, they will do what works for them. Our > local Medicare > carrier has been pretty good at sticking with the IG, but the > local Blues > here came out with a 2" thick binder for the companion guide > documents. > Many of the segments are in absolute contradiction to the IG. When I > called them on this, the response was simple...."follow the companion > guide, or else the claims will get bounced on the front end > edits. And > since the front end edits are done before the claim enters > our processing > system, if its noncompliant, it doesn't get into the system." (Legal > speak for "we never got your claim".) > > Never bothered to complain to CMS, as I need to get paid; not > worry about > the IG implementation. For most small providers, the 800 lb gorrilla > leads the way. > > The software just winds up with a lot more conditional > branches that it > should have, but the cash flow continues. We've been sending > X12 claims > to Medicare and Blue Shield now since April, with no problems so far > (knock on wood). > > Jeff Pinsky > PTFILE Systems > > ________________________________________________________________ > The best thing to hit the internet in years - Juno SpeedBand! > Surf the web up to FIVE TIMES FASTER! > Only $14.95/ month - visit www.juno.com to sign up today! > > --- > 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-testing 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 > > > --- > 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-testing 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 > --- 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-testing 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
