I don't think the California law bans using the SSN as an ID - just that
it can't be printed on an identification card. Since most everyone
knows his own SSN, that shouldn't be much of a handicap.
If Susan were able to "do" an electronic eligibility inquiry using the
name and SSN, and perhaps the adddress, then surely that same
information should be suitable for filing a claim, wouldn't you think?
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, September 19, 2003 11:47 AM
Subject: Re: Insurance cards with no Insured ID
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]
----- Original Message -----
From: William J. Kammerer
To: WEDI SNIP Transactions Workgroup List
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
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----- 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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