John, one minor quibble....criminal penalties under HIPAA (jail time) are only for wrongful disclosure of protected health information and not for non-compliance with the electronic transaction standards.
''WRONGFUL DISCLOSURE OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION ''SEC. 1177. (a) OFFENSE.-A person who knowingly and in violation of this part- ''(1) uses or causes to be used a unique health identifier; ''(2) obtains individually identifiable health information relating to an individual; or ''(3) discloses individually identifiable health information to another person, shall be punished as provided in subsection (b). ''(b) PENALTIES.-A person described in subsection (a) shall- ''(1) be fined not more than $50,000, imprisoned not more than 1 year, or both; ''(2) if the offense is committed under false pretenses, be fined not more than $100,000, imprisoned not more than 5 years, or both; and ''(3) if the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both. Rachel Foerster Chief Executive Officer Rachel Foerster & Associates, Ltd. Ideas - Promotion - Innovation 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] http://www.rfa-edi.com -----Original Message----- From: John Sherman [mailto:[EMAIL PROTECTED] Sent: Wednesday, June 04, 2003 10:52 AM To: WEDI SNIP Transactions Workgroup List Subject: RE: Payors not compliant effective on provider After November 15, 2003, Providers still have the option of submitting claims on paper, but health plans must accept standard transactions from providers if the provider chooses to submit claims electronically. If the provider submits electronically it must be in the standard format and content. Health plans and providers may use healthcare clearinghouses to assist them if they so choose. The risk to the provider of submitting paper claims is that they may not be paid as quickly as they would if they submitted electronically. The plan not being compliant should be a red flag to the provider. The plan is facing fines, possible prison for executives who ignored the law and the providers timely payment for claims is at risk. John Sherman HIPAA Project Manager Corporate Benefit Services of America (952)593-6478 Fax (952)582-2849 [EMAIL PROTECTED] -----Original Message----- From: Brenda K. Burton [mailto:[EMAIL PROTECTED] Sent: Wednesday, June 04, 2003 10:20 AM To: WEDI SNIP Transactions Workgroup List Subject: Payors not compliant effective on provider Please, if somebody could clarify/refer me to the answer (I'm sure this has been dicussed): If a payor is unable to handle electronic transactions by October 16, may they revert to paper unilaterally? What other A/R risks are present for the healthcare provider if a particular payor is not able to be compliant by October 16? Looking for contingency planning reasons. Thanks! Brenda Brenda K. 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