Re: Non-compliant inbound transactions

[PeterBarryList]

Dear Linda:

It is an understandable reaction that, if I get my own systems compliant, why should I have to ensure that the other party's systems are compliant?  Surely, it must be the sender's responsibility to make the transaction compliant, not mine.  I'm not my brother's keeper, and so forth.

Last week at the WEDI conference I termed this strategy of accepting any incoming X12 transaction as the "Laissez Faire" strategy.

I think the reason this strategy has some (small) degree of acceptance derives from misreading the General Rule which states that when a covered entity electronically CONDUCTS a transaction for which there is a standard, THE covered entity must use the standard.  Sounds unidirectional.  Sounds like it applies to the sender.

The distinction is in the word "conduct".  If the General Rule instead said when a covered entity electronically SENDS a transaction..., then the rule would be stating the laissez faire strategy.  But instead it uses the word "conduct".

It is very clear that the rule uses the word "conduct" for both transactions sent and received.  To test this usage, we can look at the Health Plan Mandate rule that states "If an entity requests a health plan to conduct a transaction as a standard transaction, the health plan must do so".

If "conduct" meant "send", then the mandate would not require a plan to receive a claim.  If it meant "receive" then the mandate would not require a plan to send a remittance advice.  There is no serious currency for such interpretation. 

So the General Rule burdens both parties to ensure the transaction is compliant.  For any transaction, which party is the first covered entity in the rule and which the second, is only perspective of subject, not direction of transaction.  It takes two parties to conduct a transaction, and the rule burdens both with ensuring the transaction complies.

Of course, next October that's not going to happen, but that is a wholly different issue from what the rule requires.  I am working on a paper to define a transition path consistent with the rules and reality.  Let you know when it is ready.

(Incidentally, Linda, my spam filter initially tossed your message out because of being a long name ending in a multi-digit number).

Peter

Peter Barry
Peter T Barry Company
Independent Consulting Health Care and Information Systems
Ozaukee Bank Building
1425 West Mequon Road
Mequon Wisconsin 53092
(414) 732 5000 (national cell)
[EMAIL PROTECTED]

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In a message dated 3/13/2003 12:10:25 PM Central Standard Time, [EMAIL PROTECTED] writes:

Subj: Non-compliant inbound transactions
Date: 3/13/2003 12:10:25 PM Central Standard Time
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet



I would really appreciate your help on this very basic question.

As part of HIPAA compliance I understand that we must send compliant
outbound EDI transactions.  My question is, are we supposed to reject
inbound transactions that are not HIPAA compliant?  Can anyone point me to
a section in the final rule or federal register (or any HIPPA official
document or IG) that states that we should reject inbound transactions that are
not HIPAA compliant?

Thanks

Linda

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