Hi Ruth, Post HIPAA, providers will send paper claims to a clearinghouse for processing for the same reason they do today, so they don't have to process paper claims in-house. Clearinghouses process millions of paper claims every month, a SERVICE that they are ASKED to perform on the part of the provider. Post HIPAA, there is no reason this cannot continue. Just because a provider could send a claim electronically does not mean that it must and just because a CH could complete an electronic transaction does not mean it must, if it receives an electronic claim from the provider with instructions to generate a paper form, it may to do so. This is not a transaction the provider intends to conduct electronically. It is not an electronic request for payment from a provider to a health plan. It has no applicable requirements under the TCS Rule.
Why would providers choose to send paper claims post HIPAA? Maybe the provider is happy with its clearinghouse and the level of electronic connectivity. Perhaps it has chosen to continue to do business with this clearinghouse knowing that it does not have 100% connectivity (it probably doesn't have much chance of getting it elsewhere anyway) and is OK with 20% - 30% of claims being sent on paper. I'm not aware of the portion of the Rule that requires a provider that is sending electronic claims today to continue to do so after HIPAA. What have you based that opinion on? Thanks for your input on the topic! Marcallee Jackson Director, Healthcare Solutions Edifecs, Inc. Office 562-438-6613 Cell: 714-865-5059 -----Original Message----- From: Tucci-Kaufhold, Ruth A. [mailto:[EMAIL PROTECTED]] Sent: Monday, January 20, 2003 3:13 PM To: WEDI SNIP Transactions Workgroup List Subject: RE: Clearinghouse Connectivity and Fees - or, Have I got a deal f or you! Chris, Your statements "Its pretty clear to me: paper is allowed as its not an electronic transaction. Even if it's faxed, its not a transaction by definition. E-transactions from the provider and the CH don't need to be in standard format. The CH is free to drop to paper but if an e-transaction is made, it must be in standard format." concerns me... if the CH is contracted by the provider to send information to the payer in a HIPAA mandated format "dropping to paper" is not an option. If the business function -- ie. electronic claims transmission -- is being done today by the provider ... then the provider must do that transaction after 10/03 in HIPAA mandated standardized format. To whom is the CH dropping the paper too? Why would a provider use a clearinghouse for its paper claims? Why would a provider enlist a CH to generate more paper? Review the definition of CH for more clarification on this relationship. or the FAQ ... at ... http://aspe.hhs.gov/admnsimp/q0101.htm http://aspe.hhs.gov/admnsimp/q0083.htm http://aspe.hhs.gov/admnsimp/q0533.htm Please clarify? Ruth Tucci-Kaufhold HIPAA Systems Analyst UNISYS Corporation 4050 Innslake Drive Suite 202 Glen Allen, VA 23060 (804) 346-1138 (804) 935-1647 (fax) N246-1138 [EMAIL PROTECTED] -----Original Message----- From: Chris Brancato [mailto:[EMAIL PROTECTED]] Sent: Monday, January 20, 2003 3:11 PM To: WEDI SNIP Transactions Workgroup List Subject: RE: Clearinghouse Connectivity and Fees - or, Have I got a deal for you! Bill, You should re-read the rules scope. The rule is explicit in establishing standard transaction sets for Electronic Transactions. The rule was only intended to cover electronic transactions and nowhere is paper excluded with the exception of the CMS clause in which it's explicit unless the Secretary grants a waiver. Some key areas I think contrary to your assertion. The rule reads " The rule does not require a provider to send or accept an electronic transaction." FR Page 50315. If that's the case and the provider is permitted to transmit claim information to a "clearinghouse" in non-standard format, there is nothing stopping the clearinghouse from merely printing that information to a claim form and submitting to the payer on paper as paper is excluded. That transaction is fully compliant. It does clearly state that if the transaction to the payer is electronic, it must be in standard formatting. I continue: " Page 50316- However, the statute permits a covered entity to submit nonstandard communications to a healthcare clearing house for processing into standard transactions by the health care clearinghouse as well as receive standard transaction through the healthcare clearinghouse." Its pretty clear to me: paper is allowed as its not an electronic transaction. Even if it's faxed, its not a transaction by definition. E-transactions from the provider and the CH don't need to be in standard format. The CH is free to drop to paper but if an e-transaction is made, it must be in standard format. Chris Brancato -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Monday, January 20, 2003 12:10 PM To: WEDI SNIP Transactions Workgroup List Subject: Re: Clearinghouse Connectivity and Fees - or, Have I got a deal for you! The HIPAA TCS rule in Subparts J through R (� 162.1000 on) enumerates the standards which the Secretary has "adopted." Paper claims are nowhere listed as "standard" transactions for the purpose of the rule. Whenever the rule refers to "standard" transactions, it means the standard X12 or NCPDP transactions. You can call HCFA 1500 or UB92 paper claim forms "standard" till the cows come home, but that doesn't make them so for the purposes of the TCS rule - which, after all, is what we are discussing! A clearinghouse covered entity has no choice but to "transmit standard transactions" (� 162.930(b)) to the payer when serving as a business associate of the provider. And "standard" does not include paper claim forms for the purpose of the TCS rule. In the case of a claim, the only choice of "standard" to transmit to the payer is the appropriate 837. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Young, Brian" <[EMAIL PROTECTED]> To: "WEDI SNIP Transactions Workgroup List" <[EMAIL PROTECTED]> Sent: Monday, 20 January, 2003 11:45 AM Subject: RE: Clearinghouse Connectivity and Fees - or, Have I got a deal f or you! William, >From what point do you make this assertion? <snip> It's called the 837; a paper claim is merely a non-standard claim. <snip> How did a paper claim, be it a H1500, UB92, State Form, TAD, etc. become a non-standard claim? I dont recall anything from the regulations that assert this idea. Granted the entire driving force of Admin. Simp. TCS and the ASCA is the elimination of paper processing; however, I dont think this fact has caused these forms to become non-standard. If we think that because of HIPAA, specifically the TCS section, that the paper world will disappear, I believe this to be false and contrary to the popular myth we all seem to be suffering. BCY Brian C. Young Accu-Med Services Inc. An Omnicare Company 300 TechneCenter Milford, OH 45150 513.831.1207 --- 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 --- 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 --- 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 --- 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
