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Wendell,
The DDE exception allowed different data formatting, but the
same data content as the standard transactions, as long as the standard
transactions are also supported. All DDE
offerings must suppliment standard transaction interchange, not replace
it.
An image file (or PDF) that displays all the
information from the 835 should suffice.
A routing such as this makes sense:
1) Generate 835
2) Print image and convert to PDF for posting at the Web
site.
3) If requested by the provider, send the 835 electronically
to the provider.
4) Under separate cover, with appropriate links to the 835,
transfer any funds involved (ACH or mail check, etc.). You may opt to
include a printed version of the 835 with a mailed check.
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]
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----- Original Message -----
Sent: Tuesday, May 27, 2003 11:11
AM
Subject: RE: Potential solutions for the
820 and 835
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]
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