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 --- 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
