It has been my understanding that if a healthcare provider asks an
insurance carrier/payer to provide any of the X12 EDI transactions, then
the carrier/payer must be able to do so effective 10/16/03 whether they do
it today or not? (with the exception of those carriers/payers that meet
certain criteria such as being a "small plan" ). So they would not be able
to get "out of it" unless they meet the criteria for exclusion. However, a
healthcare provider does not have to start using any transactions they do
not use currently. They just need to make sure that those they use today
are standard and compliant effective 10/16/03.
Gurus/ Experts - Clarification Please!
____________________________________
Kelley McCarthy
Information Systems Analyst
United Health Services Hospitals
Johnson City ,NY
607-763-5149
email: [EMAIL PROTECTED]
____________________________________
"Doug Webb"
<[EMAIL PROTECTED]> To: "WEDI SNIP Transactions
Workgroup List"
<[EMAIL PROTECTED]>
02/05/03 03:05 PM cc:
Please respond to Subject: Re: Convincing healthplans of
the need to support
"Doug Webb" 270/271
Our gurus can quote chapter and verse, but the basic rule is that a Health
Plan MUST support 270/271 AND 276/277 AND 278 AND 820 AND 834 AND 837/385
if requested by the provider, and they do the business function at all.
Thus, the only way they can get out of supporting 270/271 is by not
supporting any type of eligibility inquiries (and, if they accept claims, I
don't see how a claim could not be classified as an inquiry about
eleigibility -- getting paid says "Yes, the patient was eligibile" --
getting denied may be for the reason "the patient was not eligible")
The opinions expressed here are my own and not necessarily the opinion of
LCMH.
Douglas M. Webb
Computer System Engineer
Little Company of Mary Hospital & Health Care Centers
[EMAIL PROTECTED]
"This electronic message may contain information that is confidential
and/or legally privileged. It is intended only for the use of the
individual(s) and entity(s) named as recipients in the message. If you are
not an intended recipient of the message, please notify the sender
immediately, delete the material from any computer, do not deliver,
distribute, or copy this message, and do not disclose its contents or take
action in reliance on the information it contains. Thank you."
----- Original Message -----
From: <[EMAIL PROTECTED]>
To: "WEDI SNIP Transactions Workgroup List"
<[EMAIL PROTECTED]>
Sent: Wednesday, February 05, 2003 11:47 AM
Subject: Convincing healthplans of the need to support 270/271
We have relationships with many health plans for eligibility processing.
One
in particular has told us that their HIPAA consultants told them that they
don't need to worry about anything but the rosters they provide
doctors/groups. They seem to think online eligibility ANSI requirements
are
nice but not something they have to worry about.
Can you tell me/give me the section of HIPAA doctrine that talks about this
so I can share with them and make him aware of why they needs to pay
attention to this topic?
This is not an isolated occurance. Many healthplans I talk to do not feel
the need to support the 270/271.
Thanks for your help with this and your insights.
Larry A. Saltzman, MD'
CEO
Insurance Benefit Spot Check, Inc.
Sacramento, CA
---
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
---
This message and any attachments may contain information that is protected
by law as privileged and confidential, and is transmitted for the sole use
of the intended recipient(s). If you are not the intended recipient, you
are hereby notified that any use, dissemination, copying or retention of
this e-mail or the information contained herein is strictly prohibited. If
you have received this e-mail in error, please immediately notify the
sender by e-mail, and permanently delete this e-mail.
---
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
