RE: 835

Thu, 06 Feb 2003 08:42:13 -0800

Title: RE: 835
agreed. 
 
The actual "details" of populating the 835 is not what I am trying to emphasize... it is the fact that if the provider wants to get paid electronically after 10/03 and not send an electronic claim ... the payer has the right to ask for more information to achieve that goal...meaning that the payer could request that the standard data content be sent either on the paper claim, on a separate attachment, or both in order to populate a HIPAA compliant 835 remittance/payment. 
 
Providers (some, not all) sometimes believe that all they have to do is ... nothing ... to continue what is happening in their environment today ... and that is just not so.  They need to 'cooperate' and participate in this exchange or go back to paper completely ... and even then they might lose money because there might be charges associated with processing paper. 
 
So I guess my point is that even though the provider can request any combination of processing options, they are still going to have to become familiar with the standard data content, standard code sets, and how they are going to get paid after 10/2003.  The payer is not obligated to pay them for a non-compliant claim (outside of the "all paper" option)  either inbound or outbound.
 
Thoughts?

Ruth Tucci-Kaufhold
HIPAA Systems Analyst

MAHI Co-Founder 
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: Marcallee Jackson [mailto:[EMAIL PROTECTED]]
Sent: Thursday, February 06, 2003 10:42 AM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835

Ruth-

I had breakfast with Bob Poiesz this morning and we talked about whether a paper claim could sufficiently populate an electronic claim.  Bob agreed that the main challenge is local codes but also pointed out that a payer who uses local codes prior to HIPAA, must develop cross-walks to standard codes and so would have the capability to cross-walk the local code on a paper claim to a standard for the ERA.

Do you see any problem with that scenario or other areas that could present a problem?

Thanks for your opinion.

Marcallee

___________________________________
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: Thursday, February 06, 2003 7:17 AM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835

The provider can send a request to the payer for any type of combination of
claims submission and remittance/pymt receipt.  The rule says that the payer
cannot refuse to send/receive a transaction as requested by the provider. 

Scenarios as discussed btwn provider/payer:
1.  The provider can send paper claim and receive paper remittance 
2.  The provider can send paper claim and ask to receive an 835 -- the payer
now has the "right" to ask the provider to send the appropriate information
necessary to populate a compliate 835 if that information is not on the
paper claim because the provider cannot ask the payer to send a
"non-compliant" 835.
3.  The provider can send a 837 and receive paper remittance.
4.  The provider can send a 837 and receive and 835.

hope this helps.

Ruth Tucci-Kaufhold
HIPAA Systems Analyst

Co-Founder MAHI
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: Burke, James [mailto:[EMAIL PROTECTED]]
Sent: Thursday, February 06, 2003 8:37 AM
To: WEDI SNIP Transactions Workgroup List
Subject: 835


If a provider sends claims as paper to a payer, can the provider request an
835? Does a provider have to send an 837 to get an 835 back?

Jim Burke
EDI Programmer Analyst
Healthlink
12443 Olive Boulevard
St. Louis, MO 63141
(314)-989-6413 Phone
(314)989-6643  Fax

~*~ So long for just awhile ~*~
                                         -Jack Buck


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