George,

That is a very interesting point.  Is your assumption that the clearinghouse 
creates the transactions and has control of the code sets?  The fact that the 
clearinghouse has demonstrated the "capability" to use a certain code set 
does not necessarily mean that each one of the providers clients of that 
clearinghouse is using that same code set.  I wish life was that easy.

One of the typical "HIPAA Myths" is that the clearinghouses can magically 
make the providers compliant.  That is not the case.  Let's make sure that 
all the players understand what is their own responsibility.  If the 
expectations from providers are that their vendor or clearinghouse will take 
care of HIPAA much like they took care of Y2K, we will run into big problems 
when they wake up to the reality.

Kepa




On Monday 08 April 2002 02:58 pm, George Kaye wrote:
> If a payer performs compliance testing with a clearinghouse for code set
> effectivity for a professional claim (for example), has anyone thought
> through the process of what that testing should consist of, so that the
> payer can assume that those code sets will continue to be compliant from
> that clearinghouse on an ongoing basis regardless of: the type of
> professional claim (office visit, ambulance, physical therapy etc.), or
> when the code is impacted by new code set releases by the DSMO's?

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