Travis, even though Cook Children's is a covered entity provider, when
you enroll your own employees in an insurance program you are acting in
the role of an ordinary employer. There's no requirement for you (as an
employer) to use the standard 834 - even though every insurance plan
must be prepared to accept it if any employer wishes to use it. There's
nothing to prevent you from exchanging any mutually agreeable
non-standard format of enrollment data with your health plan - which may
simply be your current benefit eligibility transaction format.

I'll warn you, though, that my "role-based" interpretation of the rule
is fairly controversial. I've even been called irresponsible for
proffering this opinion on the 834. Folks will say a provider is a
provider, and hence a covered entity, no matter what it's doing, and
that it has to follow the letter of the rule - no matter what. Even if
it doesn't make any sense. What's so different between what Cook
Children's does with respect to enrolling its employees from, say,
General Motors, who obviously isn't mandated by HIPAA to use the 834?

The enrollment of your own employees is an employer function that has
absolutely nothing to do with your provider obligations under HIPAA to
protect patient privacy or to use the prescribed standard transactions
for electronic patient claims, remittances, inquiries, etc. It still
doesn't convince the skeptics when you tell them � 162.900(a) doesn't
even include the Enrollment or 834 (Subpart O) as a transaction required
of providers - you would think that would settle the issue once and for
all! All I can say is: don't take my word for it; you'll have to hunker
down (expensively) with your legal counsel to see if it makes sense for
you to risk "skirting" the law by not using the 834 to enroll your
employees in the health plan.

It's interesting that folks can make a really liberal interpretation of
"role" when it's their own ox being gored. The TCS rule makes it pretty
darned clear that clearinghouses must always produce standard
transactions for transmission to a payer, unless that payer has a
business associate agreement with the CH - and has explicitly contracted
to have non-standard (say, paper) produced for it; see � 162.930. In
this case, though, these folks say that clearinghouses can decide on a
moment-by-moment basis whether they're acting in the "role" of a
clearinghouse covered entity. So if the CH would rather just "dump"
claim transactions to paper because the occasion suits it, the CH can
just sprinkle magic dust on itself, taking away its covered entity
status for that moment it does the "dumping."

William J. Kammerer
Novannet, LLC.
Columbus, US-OH 43221-3859
+1 (614) 487-0320

----- Original Message -----
From: "Travis Turman" <[EMAIL PROTECTED]>
To: "WEDI SNIP Transactions Workgroup List"
<[EMAIL PROTECTED]>
Sent: Wednesday, 19 March, 2003 05:39 PM
Subject: Covered Entity as an Employer


Since a covered entity is also an employer, do enrollment/disenrollment
transactions between the covered entity and the insurance carrier used
to provide their employee health benefit plan need to use the standard
834 transaction?

Travis L. Turman
System Analyst
Information Services
Phone:  (817) 870-6490
Pager: (817) 669-0664
E-mail: [EMAIL PROTECTED]

*****************************************************************
Cook Children's Health Care System


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