Catherine, I would suggest that "X12 parlance" should not be used to define or delimit the concept of "transaction". The rule defines it as:
"Transaction means the exchange of information between two parties to carry out financial or administrative activities related to health care. It includes the following types of information exchanges: (1) Health care claims or equivalent encounter information. (2) Health care payment and remittance advice. [and the other 8]" Therefore, the X12 concept of a "transaction" being everything between an ST and an SE segment would be included in that... but so also would be considering "a transaction" to be a single service line OR the entire interchange + transport mechanism. Any/all of these concepts appear to fit within the Secretary's definition of "transaction". Some parts of the "transaction" do not yet have a standard adopted (like the transport layer). Regards, Chris At 01:29 PM 7/22/2002 -0400, [EMAIL PROTECTED] wrote: >Dawn - I'm not aware of any HIPAA-approved, (HHS/X12N/DSMO) distinction >between a clean claim and a clean transaction. I'm also not aware of the >837 IG's making that type of distinction. > >An FAQ out on the DHHS Admin Simp website states: > >If a health care provider electronically conducts a non-compliant >transaction (transmits an old National Standard Format or a proprietary >format) directly to a health plan after the transaction regulation >compliance date, and the health plan accepts and processes the >non-compliant transaction, who is in violation of the regulation? Is it the >health care provider or the health plan? >Does the acceptance and processing of a non-compliant transaction by a >health plan from a health care provider constitute a violative trading >partner agreement between the health plan and the health care provider? > >(Embedded image moved to file: pic09322.gif)11/2/2001: > > >If a health care provider electronically conducts a non-standard >transaction with a health plan after the transaction regulation compliance >date, the health care provider and the health plan are both out of >compliance. Section 162.923(a) of the rule requires a covered entity >conducting an electronic transaction for which a standard has been adopted >with another covered entity to conduct it as a standard transaction. > > >If the health plan by agreement required the health care provider to >conduct non-standard electronic transactions, such agreement would not by >its terms violate section 162.915. However, if either party were to abide >by the agreement, they would be out of compliance with section 162.923(a), >for the reason stated above. > > > > > >This FAQ talks about compliant and non-compliant TRANSACTIONS. In X12 >parlance a transaction is EVERYTHING bounded by the ST/SE. So, it appears >to me that one interpretation of this FAQ is that it would inappropriate >(illegal?) for a Payer to accept a batch 837 transaction that did not >comply with the IG...even if that error could be isolated to a single claim >within that batch. It is my understand that the entire batch is the >Transaction. > >Catherine Schulten >Sybase, Inc >6550 Rock Spring Drive >Suite 800 >Bethesda, MD 20817 >W: 301-896-1467 >C: 703-338-6955 > > > > > > [EMAIL PROTECTED] > > To: > [EMAIL PROTECTED], [EMAIL PROTECTED] > 07/22/2002 cc: > > 12:58 PM 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. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 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.
