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The loophole may be explained by the fact the
initial publication in the Federal Register omitted the "on and after October
16, 2003" for health care claims. This was corrected a week or so
later.
----- Original Message -----
Sent: Monday, September 15, 2003 3:15
PM
Subject: RE: 4010 vs. 4010A for HIPAA
Compliance
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.
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