I doubt the "Secretary" intended anything; do you think the Hons. Shalala and Thompson actually ever read this stuff? The Secretary is an important C-Level guy, and just has his minions tell him what to sign.
Anyway, as I said before, I think it would be completely permissible for the payer to accept all but the one non-compliant claim - and as a matter of fact, that may well be the technically advantageous way of handling the situation most of the time. Most any kind of X12 syntax error will be automatically detected by the translator, which will issue a negative 997; there may not be any way around this depending on the translator product. Obviously, missing mandatory segments make it awfully hard to navigate the transaction set, and makes it Dead On Arrival. There are some less serious X12 syntax errors, like trailing blanks in alphanumeric fields: should the translator completely fail the transaction set in this case? But considering X12 syntax is completely deterministic, negative 997s for even one violation don't strike me as particularly draconian, since if you fix it in one case you've fixed it for all future cases. Basically, anything that failed a WEDI/SNIP Type-1 compliance check should completely fail. Should WEDI/SNIP put together recommendations for granularity of rejections based on the testing types or levels (e.g., Types 2 through 6) that failed compliance? William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Kepa Zubeldia" <[EMAIL PROTECTED]> To: "William J. Kammerer" <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]> Sent: Monday, 22 July, 2002 10:01 AM Subject: Re: When is a claim a standard claim? William, When a provider sends 3,654 claims, and one of them is bad... I don't think the providers are going to agree with the idea that it is OK to reject all of them because the one bad claim in the file. If the other 3,653 claims are HIPAA compliant, can the payer refuse them? Isn't the payer required to conduct the standard transactions? Here is where the world of EDI and the world of business collide. It may be an invalid 837 because it is tainted by a bad claim... but is that what was intended when the Secretary adopted the 837? Kepa ----- Original Message ----- From: "William J. Kammerer" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Sunday, 21 July, 2002 12:32 PM Subject: Re: When is a claim a standard claim? May I suggest that this thread be moved to just one or the other of the WEDI/SNIP Business Issues or Transactions listserves? Cross-posting (on the WEDI/SNIP listserves) runs counter to Zon Owen's SNIP Listserv Usage & Etiquette Guidelines (2002-04-01) at http://www.mail-archive.com/business%40wedi.org/msg00311.html. A recipient *may* reject an entire 837 transaction set if even only one claim within is "tainted," but I doubt the law forbids more "fine-grained" rejection. As Kepa noted, many of the semantic issues may not be discovered until well into the back-end, long after the transaction set has been translated. It may be difficult to "rollback" thousands of correct "claims" within a single 837, for example, just because the 3654th claim had a semantic inconsistency of the type Ellen Falbowski mentioned: e.g., data from the CR1 Ambulance Transport Information segment is missing when the payer finally discovers, deep in the back-end, that an ambulance type Procedure Code was used. Since the 824 (004050X166) allows for selective rejection, the payer, if she prefers, could accept all but the erroneous claim (items), or all claims for the particular patient which contained the erroneous claim line item, or the entire 837 - depending on what floats her boat (technically and business-issue wise). The provider (or billing service or CH) would have no call to complain if the payer were to reject the entire 837 since it is, in effect, non-compliant; but at the same time, he certainly would not object to the selective rejection of erroneous claims - which obviously allows him to get paid for the clean claims, however. The payer is not refusing to accept the standard transaction - the most important part of the law, strongly emphasized throughout the TCS Rule. And the provider still has not been given an artificial incentive to not use the standard transaction, because he still hasn't gotten paid (for the one invalid claim) even if the payer adjudicates the remainder of the 837 (not because she is necessarily generous, but probably because it's actually simpler for her). Everyone's happy: why should the HIPAA Stasi get involved? William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 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.
