RE: Type of Service still needed?

[Koller, Greg]

Title: Message

Speaking from a clearinghouse perspective (one who is asking for this to be done), this is a temporary requirement to address conversion from current payer formats to final HIPAA formats. Bottom line is the clearinghouse has to Masters to serve, and if we can get one side up to compliance (or near compliance), then we have the ability to test and convert the other side. TOS is the glaring reverse gap from an ANSI 4010 back to an NSF. By including this element for the period between now and October, the provider will not have to make changes (hopefully) as payers go from Current formats to compliant formats. When the payers are all tested and converted, there will be one small change (controlled) for the provider. And if the provider cannot make the change by October 16th, they can still be in compliance via the relationship with the clearinghouse. Hope this makes sense.  -----Original Message----- From: Doug Webb [mailto:[EMAIL PROTECTED] Sent: Thursday, March 20, 2003 8:36 AM To: WEDI SNIP Transactions Workgroup List Subject: Re: Type of Service still needed? Kerry, I would suggest that you work with your clearinghouse(s) to ensure that YOU don't have to send non-complient claims come October.  What non-complient format they send to the payers you don't care about, but they should be the ones to do the table look-up, not you (and the payers should be the ones paying the CH to do the lookup and maintain the list, not the providers).  If this is done, the process is complient in your view (no cause for complaint either against the CH or payer).   I would like to see a list from the clearinghouses that indicates which payers are fully complient (the CH is not a HIPAA CH, but a dispatcher and error checker), and which receive/send proprietary formats (and, come October, 4010 without the Addenda is one of these).  I don't expect to see these popping up until we get real close to October (too much maintenance work), but the information would be useful.  I like to know what services I am paying my CH to do.   P.S. Requiring Insured DOB & Sex is complient and annoying.  Since it is complient, we're reduced to the soldier's pastime, griping.   Please pray for our soldiers in battle.   The opinions expressed here are my own and not necessarily the opinion of LCMH.   Douglas M. Webb Computer System Engineer Little Company of Mary Hospital & Health Care Centers [EMAIL PROTECTED]   "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s)  named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately,  delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you."     ----- Original Message ----- From: Kerry Zajicek To: WEDI SNIP Transactions Workgroup List Sent: Wednesday, March 19, 2003 06:11 PM Subject: RE: Type of Service still needed? L2400 SV106   Most of our providers are using a clearinghouse and TOS is included in their companion guide. It just indicates that TOS is situation and is needed for those payors that may still utilize them.      -----Original Message----- From: Tiffany Gutraj Rosik [mailto:[EMAIL PROTECTED] Sent: Wednesday, March 19, 2003 5:33 PM To: WEDI SNIP Transactions Workgroup List Subject: RE: Type of Service still needed?   I am just starting Medicaid programs by state for my company. Can you tell me what Payers are requiring this information?  And to what loops and segments you are adding this information?   Any help you could provide would be appreciated.   Tiffany Gutraj Rosik Product Analyst Amicore -----Original Message----- From: Kerry Zajicek [mailto:[EMAIL PROTECTED] Sent: Wednesday, March 19, 2003 4:48 PM To: WEDI SNIP Transactions Workgroup List Subject: RE: Type of Service still needed? Many of our providers are running into the same thing, especially with the Medicaid's. Because of edits in place today we had to add TOS to our ANSI 4010 format. I was not aware that this requirement might extend past October.   We are also finding that some payors are currently requiring in the 4010 the responsible party's DOB and sex.     -----Original Message----- From: Stacy Trease [mailto:[EMAIL PROTECTED] Sent: Wednesday, March 19, 2003 2:42 PM To: WEDI SNIP Transactions Workgroup List Subject: Type of Service still needed?   Many of the payers we have been testing with are informing us that they will still need to receive the type of service code for claims after 10/16/2003.  In the implementation guide, SV106 is marked as not used.   Is anyone else running into this, and if so, how have you been handling it?    Thanks for your input! Stacy M. Trease EDI Programmer/Analyst, Gateway EDI Inc. 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