4010 without the addenda is compliant for those who did not file an extension "for the period from October 16, 2002 through October 15, 2003" (quoting the " Modifications to Electronic Data Transaction Standards and Code Sets" final rule).
However, this rule also makes it clear that the only compliant version after October 16, 2003 is 4010 A1. As an example, here are the references for the Professional Claim: §162.1102 Standards for health care claims or equivalent encounter information transaction. ... (b) For the period on and after October 16, 2003: ... (3) Professional health care claims. The ASC X12N 837 − Health Care Claim: Professional, Volumes 1 and 2, Version 4010, May 2000, Washington Publishing Company, 004010X098 and Addenda to Health Care Claim: Professional, Volumes 1 and 2, Version 4010, October 2002, Washington Publishing Company, 004010X098A1. (Incorporated by reference in §162.920). I don't see a loophole, since it says "AND Addenda....". Larry Watkins Executive Vice President Claredi Office: 801-444-0339 x204 Fax: 770-419-5295 Mobile: 678-463-0885 Email: [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Monday, September 15, 2003 5:00 PM To: WEDI SNIP Testing Subworkgroup List Cc: WEDI SNIP Testing Subworkgroup List Subject: Re: 4010 vs. 4010A for HIPAA Compliance I wonder what is being interpreted as a "loop hole"? Anthem's interpretation is that only version 4010 A1 is compliant as of 10/16/2003. Cathy M. Ewbank HIPAA Program Manager (317) 488-6172 "Karyn White" <[EMAIL PROTECTED]> To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> 09/15/2003 03:43 cc: PM Subject: Re: 4010 vs. 4010A for HIPAA Compliance Please respond to "Karyn White" Our clearinghouse house said there is a "Loop Hole" in the final rule regulation and some of the payers are considering themselves compliant with the 4010. Too bad for providers, who thought this was a standard transaction. >>> "Connie Hein" <[EMAIL PROTECTED]> 09/15/03 01:53PM >>> We have been working with a client who contracts with one of the major clearinghouses to conduct transactions. This clearinghouse has stated that they will not be able to accept 4010A transactions as of October 16, 2003. Rather they will only accept 4010 version. Is the payer compliant if they only accept version 4010 after the compliance deadline? It is our understanding that 4010A is necessary for compliance, but they are telling us differently. Thanks in advance for your response. Connie Hein Senior Consultant Paramore Consulting, Inc. --- 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. 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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/. 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