Susan, Generally, HIPAA standards require a covered entity to respond with all available responses that could be expressed in the EDI transaction included in the EDI. Refer to official comments in the regulation at page 50335 and others. Additional information provided by a separate mechanism is allowed, but the outcome of the transaction cannot be determined by it.
Specific to the 278 segments below, using code 18 to indicate this a final response, but then following it with either paper or phone responses appears to conflict with the meaning of the code. Additionally, the CT code indicates a non-EDI transmittal of a medical decision - so the outcome would have to be a "medical decision" as opposed to an eligibility or health plan requirements decision. Regards, Leah Hole-Curry FOX Systems, Inc. 602.708.1045 Information transmitted is confidential and may be proprietary to FOX Systems, Inc. It is intended only for the person or entity to which it is addressed. Anyone else is prohibited from disclosing, copying, or disseminating the contents or attachments. If you receive this in error, please notify sender immediately, or us at www.foxsys.com and delete from your system. >>> "Brousseau, Susan" <[EMAIL PROTECTED]> 06/21/02 06:13 AM >>> Is it allowable to send an electronic response to the 278 indicating that the actual response to the transaction will be by phone or on paper? Page 220 of 278 IG BHT06 Transaction Type Code18 Response - No Further Updates to Follow Use this code to indicate that this is a final response. If the final response reports a medical decision it contains an HCR01 value of A1, A3, A6,or NA in Loop 2000F. This indicates that no additional EDI responses are necessary or forthcoming from the UMO in relation to the original request. Note: If you use HCR01 = CT to indicate a non-EDI delivery of the medical decision, use it in combination with BHT06 = 18. Confidentiality Notice: The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank you. Medica Health Plans ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ====================================================== 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.
