Thanks for the clarification! Paul
----- Original Message ----- From: "Marsha E Solomon" <[EMAIL PROTECTED]> Date: Thursday, February 6, 2003 3:44 pm Subject: Re: RE: RE: 835 > > 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 > adoptedthe 276/277 Set. > > The 837s stand alone and do not impact the use of any other > TransactionSets. 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'swhy 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 > standalonetransaction 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 > confidentialand 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 > originalmessage. > > > > > > > > > > > > > > "Paul Costello" > > <paul.costello@cg To: "WEDI > SNIP Transactions Workgroup List" > i.com> <wedi- > [EMAIL PROTECTED]> > > cc: "WEDI > SNIP Transactions Workgroup List" > 02/06/2003 03:31 <wedi- > [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. 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They also are not intended to be used as a forum for > personaldisagreements 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/Unsubscribeform 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/. 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