Group, I have a question regarding "accepting" and standard transaction and "processing" a standard transaction.
I was under the impression that in order to meet the HIPAA guidelines, a covered entity only had to be able to accept a standard transaction, but not necessarily process with all the data elements that come in. Also, my understanding was that from a payer's perspective, HIPAA does not mandate that payers completely change their core business processes in order to process a standard transaction. Am I off-base? For example, if a payer only processes claims that come in at the line-level and it receives claims at the claim-level, is the payer still obligated to pay the claim-level claims, or can it just accept the claim-level claim (meeting HIPAA requirements) but not pay? Another example would be when anesthesia charges are billed on a claim, certain health plans currently require the surgical CPT code rather than the anesthesia CPT code. If a provider, post October 16, 2003, sends an anesthesia CPT code, payers have to accept the claim with the anesthesia codes (understood), but do they have to pay? Can they say that their systems only process using surgical CPT codes, so in order to get paid, providers must send anesthesia charges using surgical CPT codes? Wouldn't these two examples be instances where "companion guides" might be used? Any insight is appreciated. Thanks, Paul --- 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
