p. 50314 ... 2nd column TCS Rule:
With respect to health plans, a health plan is required to have the
capacity to accept and/or send (either itself, or by hiring a health
care clearinghouse to accept and/or send on its behalf) a standard
transaction that it otherwise conducts but does not currently support
electronically. For example, if a health plan pays claims
electronically but historically performed enrollment and disenrollment
functions in paper, the health plan must have the capacity to
electronically perform enrollment and disenrollment as well as claims
payment as standard transactions by the applicable compliance date of
the regulation.
Also, in response to the public's need for clarification of the
applicability of the HIPAA administrative simplification provisions (45
CFR subtitle A, subchapter C) to covered entities, we revisited the
applicability provision with respect to health care providers. In the
proposed rule, we proposed that the administrative simplification
provisions would apply to a health care provider when transmitting an
electronic transaction (63 FR 25305). (We note that this language
differed somewhat from the statute, which states that the HIPAA
administrative simplification provisions apply to ``a health care
provider who transmits any health information in electronic form in
connection with a transaction'' referred to in subchapter C.)
does this help?
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: Matthew Fuller [mailto:[EMAIL PROTECTED]]
Sent: Thursday, February 06, 2003 2:21 PM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835
Must the payers be able to provide an 835 to any provider who requests
one as of 10/16/2003? I am getting carriers who are stating that they
only send paper remittances, and won't have an 835 transaction ready by
10/16/2003 (or not even planned to have one in the future).
Thanks
Matthew Fuller
MMRI
-----Original Message-----
From: Rachel Foerster [mailto:[EMAIL PROTECTED]]
Sent: Thursday, February 06, 2003 2:08 PM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835
Short answers:
1. Can the provider request an 835
A. Yes, and the payer must then comply
2. Does provider have to send an 837 in order to ask for an 835 A. No
Rachel Foerster
Principal
Rachel Foerster & Associates, Ltd.
Professionals in Health Care EDI
39432 North Avenue
Beach Park, IL 60099
Voice: 847-872-8070
Fax: 847-872-6860
eMail: [EMAIL PROTECTED]
http://www.rfa-edi.com
-----Original Message-----
From: Burke, James [mailto:[EMAIL PROTECTED]]
Sent: Thursday, February 06, 2003 7:37 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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