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William,
Mainly because of the "I dunno" response from the insurance
company. That indicates to me that they have no idea what the proper ID
is. If they had come up with any positive response, working with them
would be, indeed, the better option.
They're being a pain, and blaiming HIPAA when the cause is
California law banning the use of SSN as ID. Sometimes, the only way to
get some payers (most are great guys, but a few...) to clean up their
act is to apply pressure from the ones who are actually paying them (the
policyholders).
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
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----- Original Message -----
Sent: Friday, September 19, 2003 10:02
AM
Subject: Re: Insurance cards with no
Insured ID
Doug, why can't Susan file the claim? The patient surely
knows her own
SSN, so leave off the member ID on the Subscriber NM1, and
include a
secondary reference to the SSN. Can't insurance companies find
out which
subscriber (or patient) is being referred to solely by the name
and the
SSN? They have computers, don't they? Why put the patient in
the middle
of this?
William J. Kammerer
Novannet,
LLC.
Columbus, US-OH 43221-3859
+1 (614) 487-0320
----- Original
Message -----
From: "Doug Webb" <[EMAIL PROTECTED]>
To: "WEDI SNIP
Transactions Workgroup List"
<[EMAIL PROTECTED]>
Sent:
Friday, 19 September, 2003 10:04 AM
Subject: Re: Insurance cards with no
Insured ID
Susan,
1) Blaming HIPAA for this fiasco is totally
bogus.
2) "I dunno" is a totally unacceptable response from the
insurance
company.
3) If you can't get a vaild insurance ID, you
can't file a claim. A 270
query MAY reval the proper
information. You shouldn't have to do so to
get a valid ID.
Bill the patient. Inform the the insurance company
that you will do
this, and will give the patient X days to pay before
being referred to your
collector. The insurance company will probably
respond "You can't do
that!"; you can respond "We can and will if you
don't clean up your
act!"
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:
Susan Hollabaugh
To: WEDI SNIP Transactions Workgroup List
Sent: Friday, September 19, 2003 07:17 AM
Subject: Insurance cards
with no Insured ID
We have begun receive patients in our
California Imaging Centers who
present Insurance cards with no Insured
ID.
Here is the experience as reported from our Director in the
region:
"One Health Plan and Aetna are issuing new insurance cards
without the
Insurance Identification Number. I called both insurances to
ask why,
and was told, "HIPAA". Both are in the process of issuing new
cards to
ALL members
So I asked, the patient, "what is your
Insurance ID number?". "I dunno"
, was the answer
So I asked the
insurance companies, "are we to assume that the ID number
is the social
security number?" "I dunno" , was the answer. They would
not provide me
with the ID number."
How are we going to bill a patient's insurance
company under these
circumstances? How are others dealing with this
situation? Will this
necessitate Eligibility verification? Could we find
the information that
we need that way? If this extends throughout the
market, it will be a
nightmare for providers.
EDI Project
Manager
8754 Dunstable Loop
Bristow, VA
20136
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