RE: When is a claim a standard claim?

[David Frenkel]

Dawn, I would agree with your comments.  For example Medicaid agencies are under political pressure (among other things) to pay medical claims as soon as possible.  The agencies I am familiar with have policies you referred to of rejecting only claims that are in error and I would not see this changing under HIPAA.   Rejecting a whole transmission of valid claims because of one bad one might also come into conflict with state prompt pay laws.   Regards,   David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030   (P.S. Can we try to follow the laws of Zon and not cross post emails.)   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Monday, July 22, 2002 9:59 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: When is a claim a standard claim?   Responding from a physician based level, as well as a patient, this discussion about when to pay and whether or not to reject an entire batch of individual claims based upon one noncompliant element of one claim within the batch seems to have one simple answer.  The industry is well used to sending and receiving batches of multiple claims and sorting the multiple claims into acceptable and unacceptable for some reason.  I fail to see the difference here.  Most medical practices batch their claims daily to insurers, and any disruption of the orderly handling of that batch from submission to payment is costly in terms of resources to both sides.  It only makes sense to allow "clean" claims to continue through the process and reject only incomplete claims, without rejecting a batch full of perfectly appropriate and compliant claims.  That would seem to be the only solution that is consistent with the original philosophy behind the HIPAA regulations.  If there are no regulatory explanations developed supporting rejection of individual claims for noncompliance, rather than full batches, I would expect that the general marketplace would enforce that solution anyway.  In this era of  public and private entities monitoring physician/payor relations and the ultimate effect disruptions in those relations have on patients, it behooves us all to maximize the benefits of the HIPAA regulations. Dawn The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.