Dear Margaret and Steven:
A couple references that might also help. From the SNIP paper Impact on DDE
Services, July 31, 2001, Version 1.0:
Paragraph 8.2 explains that an inquiry fits the definition of transaction,
that if it is a transaction for which there is a HIPAA standard, such as
eligibility inquiry and response, then either the HIPAA standard must be
used, or if it qualifies for the direct data entry exception, then standard
data content and conditions must be met but the format in both directions may
be as appropriate for the DDE medium. (Note the Utah system converts the
transmission to standard, including format). It is still a transaction
subject to the rules.
Paragraphs 8.6 to 8.9 explain that the requirement is for the same data
content and conditions. That includes more than code sets.
Paragraphs 8.10 to 8.11 explain some leeway given us in data length and
number of line items because of the manual data entry character of DDE
services.
Paragraph 8.12 deals with the richer data content question. I think in
hindsight that this paragraph goes beyond HHS instructions on the subject and
there are health plans appearing to drive a truck through the difference. In
the next version of the paper, we'll straighten this out. What HHS actually
said was:
"A health plan may not add additional information to any of the standard
transactions. It may, however, provide additional information through a
separate mechanism. For example, the web-based service described in the
question could provide additional information on a web page separate from the
web page containing the standard data content. The resolution of the standard
transaction cannot depend on the additional information."
The SNIP paper, Impact on DDE Services, July 31, 2001, Version 1.0, is
available from the SNIP web site. Go to wedi.org, click SNIP, click
WorkProducts, click Transactions, download the DDE paper.
Hope this helps. Let me know if I can help.
Peter
Peter Barry
Peter T Barry Company
Independent Consulting Health Care and Information Systems
Ozaukee Bank Building
1425 West Mequon Road
Mequon Wisconsin 53092
(414) 732 5000 (national cell)
[EMAIL PROTECTED]
------------------------
In a message dated 5/30/2002 8:34:21 AM Central Daylight Time,
[EMAIL PROTECTED] writes:
> Subj: RE: Internet Transaction limitations?
> Date: 5/30/2002 8:34:21 AM Central Daylight Time
> From: [EMAIL PROTECTED] (Stanley Nachimson)
> To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED]
>
> The eleigibily inquiry you mentioned directly into a payer's system sounds
> like a DDE transaction. If the web page is the plan's, then it would also
be
> DDE.
>
> Stanley Nachimson
> HIPAA Project Team, CMS
> 410-786-6153
>
> >>> Stephen Block <[EMAIL PROTECTED]> 05/30/02 09:23AM >>>
> I think this requires further clarification. Is an inquiry for eligibility
> made directly into a payer's system (through the Web or otherwise)
> considered an EDI transaction? Is it EDI if the same inquiry is built on a
> web page if the web page is sponsored by the plan? I was under the
> impression that the 270/271 transactions are intended for system-to-system
> inquiries. I definitely could be mistaken.
>
> Stephen C. Block
> Director, Information Services
> St. Joseph's Hospital Health Center
> 301 Prospect Ave.
> Syracuse, NY 13203
> (315)-448-5613 (phone)
> (315)-448-5424 (fax)
>
> -----Original Message-----
> From: Stanley Nachimson [mailto:[EMAIL PROTECTED]]
> Sent: Thursday, May 30, 2002 8:32 AM
> To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
> Subject: Re: Internet Transaction limitations?
>
> Your understanding is not entirely correct. The requirements for
> web/Internet transactions depends on whether they are a Direct Data Entry
> transaction (ie a provider entering data directly into a plan's system via
a
> web page) or a transaction built on a web page and then sent via the
> Internet to the plan. If the former, then the transaction must be
compliant
> with data content and coding requirements of the standards; no proprietary
> coding. Additional functions can be made available via optional screens;
> but providers cannot be required to use these to complete a transaction.
>
> If the latter situation exists, then the transaction must be both data
> content and format compliant.
>
> Stanley Nachimson
> HIPAA Project Team, CMS
> 410-786-6153
>
> >>> <[EMAIL PROTECTED]> 05/29/02 07:28PM >>>
> Am I correct that web/Internet based transactions do not have to comply
> with the format of the standard transaction (ANSI)
> but the content with respect to the code sets must comply?
>
> For example, when a provider inquires about a patient's
> eligibility/benefits via the Internet, may I respond with information
> which is from our proprietary system (such as member ID suffix)? May we
> send back via the screen information and fields
> which is not contained in the ANSI transaction, or are we limited to the
> scope of that transaction, even if the format is not
> required to be compliant?
>
> Thank you,
> =================================
> Margaret Shilling
> Manager, Trading Partners
> The Regence Group
> Phone: 253.573.3407
> Email: [EMAIL PROTECTED]
>
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