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Forget
about Medicaid, I can't help. In all seriousness, that is a major issue that
violates the plan. Medicaid requires their additional elements that cannot be
found on any "standard" including the NSF. I go home a say a little prayer that
they will hurry up and go to production with ANSI, or relax these elements as an
interim. There is always the P word, right?
Greg,
Your perspective makes a lot of sense.
Let's hope that TOS is the only interim data item we have to
deal with, and that the payers get their acts in gear soon. (Expecially
Medicaid).
In the meantime, Clearinghouses have a great business
opportunity. May the payers line your pockets with green.
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
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----- Original Message -----
Sent: Thursday, March 20, 2003 10:19
AM
Subject: RE: Type of Service still
needed?
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.
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
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----- Original Message -----
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.
Co-Chair,
MO SNIP TCS Subcommittee
(800)
969-3666 Ext 224
[EMAIL PROTECTED]
------------ Gateway EDI, Inc.
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