Hi all,
An interesting scenario has come up that I wanted to ask this group
about. Some folks around the office have been asking about the creation and
submission of what-if type transactions through the web. The specific
scenario would let a provider fill out some level of claim information,
click a button, and have the payer site give the provider a reply saying
something like "If you were to submit a claim with the information you just
included, your claim payment would be X." A key point here is that the
claim has NOT been submitted for payment to the payer, and no data has been
stored on the payer system. The question is whether this scenario qualifies
as a covered transaction as defined by HIPAA? Since I am not requesting
payment, or initiating another payment mechanism based on an encounter, I do
not seem to be performing an 837 or any other covered transaction.
Thoughts?
Chris Heinefield
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