Paul,
I believe you've been given information which is incorrect.
Each of the three X12 837s is a Transaction Set.
The X12 835 is a Transaction Set.
The Eligibility Inquiry and Response is an X12 270/271 Transaction Set
The Claim Status Inquiry and Response is an X12 276/277 Transaction Set
... understanding that there are about 5 different types of 277
transactions and HIPAA has in this initial set of standards only adopted
the 276/277 Set.
The 837s stand alone and do not impact the use of any other Transaction
Sets. So a Provider is absolutely within their HIPAA "rights" to submit
paper claims and request X12 835 electronic remits.
The same does NOT hold true for the two "combo" Transaction Sets. That's
why they are referred to as Sets. For these a 271 is only created in
direct response to either the batch or realtime receipt of a 270. As far
as the HIPAA mandated 277, it is created in direct response to either a
batch or realtime receipt of a 276.
Completely separate from HIPAA is the use by our industry of the
Unsolicited 277. This transaction - as its name implies - is a standalone
transaction and is a unique "Set" unto itself. There are many commercial
Payers, Medicaid Health Plans, Medicaid State Agencies, Medicare FIs and
large Providers that send out, or receive Unsol277s today as part of their
electronic claims or encounter processing flow.
So it is not true that a provider could fax a list of eligibility inquiries
- for example - and expect an X12 271 Response ... under the gize of HIPAA
compliance... that's not a compliant scenario. And actually its not even
an X12 compliant scenario. I am not aware of an Unsolicited 271.
Hope it helps
Marsha
Verizon Information Technologies Inc.
Managed Care Division
Phoenix, AZ
Phone - 602.678.6042
Fax - 602.678.6331
E-mail - [EMAIL PROTECTED]
Confidentiality Notice: This e-mail message, including any attachments, is
for the sole use of the intended recipient(s) and may contain confidential
and privileged information. Any unauthorized review, use, disclosure or
distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of the original
message.
"Paul Costello"
<paul.costello@cg To: "WEDI SNIP Transactions
Workgroup List"
i.com> <[EMAIL PROTECTED]>
cc: "WEDI SNIP Transactions
Workgroup List"
02/06/2003 03:31 <[EMAIL PROTECTED]>
PM Subject: Re: RE: RE: 835
Please respond to
"Paul Costello"
All I am saying is that similar to the 837 / 835 relationship, the
method in which a claim status inquiry or eligibility benefit inquiry
is conducted does not necessarily dictate the method used to respond.
I would argue that if a provider called a health plan or sent it a
paper list of 10 patients wanting eligibility benefit information, the
provider could request that the health plan respond with a 271, and the
health plan would have to abide by the request and create a HIPAA-
compliant 271 transaction based on the paper / phone call inquiry.
Paul
----- Original Message -----
---
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
