While there is agreement that the X12 transactions must still be supported even with the DDE, there is one provision of solution #1 that could use some discussion. The statement, "The provider will be able to view and print the remittance advice" implies that a remittance advice (835 type data) will be downloaded.
Is this compliant? If the argument is that it okay because it is a paper image, can file formats such as PDF be used (anything other than text file that can be directly sent to a printer)? If not compliant, would electronic delivery of the "paper image" be compliant if an actual 835 is also exchanged? My experience is that even after the 835 is implemented, providers want the paper image "crutch" for some time. CMS has stated that a faxed document (such as remittance data) must be compliant if the fax originated from a computer. Seems the same situation exists if the data is web delivered. Your thoughts and discussion are welcomed as always. Wendell Broome EDI Team Leader Priority Health 616-464-8284 [EMAIL PROTECTED] -----Original Message----- From: James kelly [mailto:[EMAIL PROTECTED] Sent: Friday, May 23, 2003 4:04 PM To: WEDI SNIP Transactions Workgroup List Subject: RE: Potential solutions for the 820 and 835 Carol, I am in total agreement with Mimi and Doug. As a health plan you must conduct as standard (defined in the regs as X12 EDI) if requested to do so and you support that business. So in general, the answer to your question is NO, these solutions would not satisfy the requirements you have under HIPAA. You must fully support, either directly or through the use of a BA, all standard transactions for which your health plan's business model currently support (i.e. if no dental benefits, then no 837D, no authorizations required then no 278, etc...). Since it seems that you do support the business models for these 4 solutions, then you MUST be able to support full X12 transactions for these business models. I know this is not the answer you were looking for, but that's HIPAA for you! If you would like more information on some cost effective solutions for small to mid-size health plans that I know of, please contact me off-line. Jim Kelly TPA Computer Corp. -----Original Message----- From: Mimi Hart [mailto:[EMAIL PROTECTED] Sent: Friday, May 23, 2003 12:18 PM To: WEDI SNIP Transactions Workgroup List Subject: Re: Potential solutions for the 820 and 835 I am in total agreement with Doug's take on this, it sounds wonderful, I am sure there will be many providers who will be happy to use it. But it is still providers doing data entry to get information, and then taking the information and keying it into their own system, which, to me, negates part of what the regs are trying to accomplish, which is to streamline these processes, make them less labor intensive, and hopefully save money in the long run. Please, no flames, I understand the reality of what this is costing on all sides. If my system can send a 270 or 276 with little or no human intervention, and take a 271 or 277 in the same way, that is far preferable to hitting someone's website, no matter how user friendly. My personal opinion only...Mimi Mimi Hart ӿ�* Research Analyst, HIPAA Iowa Health System 319-369-7767 (phone) 319-369-8365 (fax) 319-490-0637 (pager) [EMAIL PROTECTED] >>> "Doug Webb" <[EMAIL PROTECTED]> 05/23/03 11:14AM >>> Potential solutions for the 820 and 835Carol, With the content you mentioned, these could supply a DDE path for providers to access their information. If you make it easy enough to use, it might even become the primary way for providers to access their information. Make sure that the connections to the sites and the sites themselves are secure. However, this DDE path must be IN ADDITION to the ability to exchange standard transactions with the provider, not in place of it. 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: Carol.Krause To: WEDI SNIP Transactions Workgroup List Sent: Friday, May 23, 2003 10:25 AM Subject: Potential solutions for the 820 and 835 Our organization is considering the following methods for the fulfilling the 820, 835, 276/277, and 270/271 transactions. I am wanting the groups thoughts on whether these would be HIPAA acceptable methods of performing these transactions. I stipulate that I understand that any of these solutions would have to comply with the content specifications of the HIPAA transaction. Solution #1 - 835 Health Care Claim Payment/Advice to a Provider A company, which will be a Business Associate of ours, will host a website that will allow a provider to view remittance advice information on-line. The provider will be able to view and print the remittance advice, and they will be able to receive an electronic funds transfer. The provider will also be able to view paid claims and previous check information. The provider will not be able to edit claims information. The provider will be logging directly into the Business Associate's website. Solution #2 - 820 Payroll Deducted and Other Group Premium Payment for Insurance Products for Employer Groups We would purchase a web portal product, which we will host and will reside in our physical plant, available via the internet, that will allow employer groups to view their on-line electronic premium bill and then, if they choose, pay that bill electronically. The employer group will be able to edit this premium bill to add or delete employees, as needed, and print the bill if they want. (The addition of an employee will require the employer group to take additional steps. While the bill will be automatically adjusted, the employee will not be officially added until the group takes the additional steps. I realize that the 834 transaction is relevant to this situation.) As indicated, we are maintaining this website in-house. Solution #3 - 270/271 Eligibility Benefit Inquiry and Response and 276/277 Claim Status Request and Response We have a website that will allow a provider or employer group to log-on and check member eligibility and claim status. The information is coming directly from our systems which are in-house. We created and maintain the website. We are considering use of this site for the 834 Benefit Enrollment transaction and for the 278 Services Request for Review and Response. Your views on these potential solutions is appreciated. Carol F. Krause Business Analyst Health Alliance Medical Plan (217) 383-8182 [EMAIL PROTECTED] --- 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. 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