Colleen, I respectfully disagree with your conclusion that they are solely performing a clearinghouse function. I don't believe that clearinghouses actually adjudicate and pay a claim. Rather, this is usually a function that is performed by the payer. If the payer then hires another company to perform that function for them, that outside company is a business associate. A clearinghouse under HIPAA is defined as any entity that translates non-standard data/format into the standard or vice versus. This company is scanning paper claims into a document imaging system and then keying the data into an adjudication system. This company's existence and role is totally transparent to the provider/payee. Thus, this company isn't translating non-standard data/format into standard, but is actually adjudicating the claim, and making payment based on the results of that adjudication.
This is the rationale I used when concluding that the company is a business associate, but not necessarily a clearinghouse. I agree that a clearinghouse can play both the role of a CH and a business associate, but I don't think this company is doing so in this instance. Thus, my recommendation to seek their own legal counsel opinion. If their legal counsel concludes they are in effect a clearinghouse then there are much broader implications for them as a covered entity that if they are only a business associate of a covered entity. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http://www.rfa-edi.com -----Original Message----- From: Grimes, Colleen [mailto:[EMAIL PROTECTED]] Sent: Monday, June 24, 2002 11:30 AM To: '[EMAIL PROTECTED]' Subject: RE: A Clearinghouse By Any Other Name ... You should always check with you legal department, but what you are describing sounds like a clearinghouse function. A clearinghouse can be a buisness associate and a trading partner. Thanks, Colleen > -----Original Message----- > From: Rachel Foerster [SMTP:[EMAIL PROTECTED]] > Sent: Monday, June 24, 2002 11:44 AM > To: [EMAIL PROTECTED] > Subject: RE: A Clearinghouse By Any Other Name ... > > My opinion is that you are a business associate of the health plan, which > has outsourced this function to you to perform on their behalf. Best > course > of action is for you to confirm this with your company's legal counsel AND > the legal counsel of the health plan for which you perform these services. > > Rachel Foerster > Principal > Rachel Foerster & Associates, Ltd. > Professionals in EDI & Electronic Commerce > 39432 North Avenue > Beach Park, IL 60099 > Phone: 847-872-8070 > Fax: 847-872-6860 > http://www.rfa-edi.com > > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] > Sent: Monday, June 24, 2002 9:45 AM > To: [EMAIL PROTECTED] > Subject: A Clearinghouse By Any Other Name ... > > > > > Would anyone here have an opinion of "what type of entity", from a > > HIPAA Transaction Rule perspective, the following operation could be > > categorized? > > > > I have an operation that receives; on behalf of a HEALTH PLAN, paper > claims > > from the PLAN's health care PROVIDERS (doctors, hospitals, etc.). > > > > We then take the paper claims; scan them into an imaging system, key the > > claims into our own claims processing software system (off the scanned > image > > of the paper claim), adjudicate the claim, cut the paper check and EOB > > and/or ERA and mail. > > > > The submitting providers; and the payee's on the backend have no knowledge > > of us. The checks bear the logo/address/signature of our health plan > > clients. > > > > And the address where the paper claims are mailed have the name of our > > health plan clients; with a PO Box that we set up; and from which we > collect > > the inbound mail. > > > > Question: does this make us a "CLEARINGHOUSE"? [I had, naively perhaps, > > assumed that a "HIPAA defined clearinghouse" was one that reformatted data > > from a non-HIPAA standard format to a HIPAA standard format or vice-versa; > > and I had assumed that the media on both sides of this are electronic - > but, > > when I look at the definition below; perhaps the rule applies to "paper" > as > > a 'non-HIPAA standard format' as well.]. > > > > > > > > Definition below for convenience - from the WEDI/SNIP Glossary > > > > Health Care Clearinghouse: Under HIPAA, this is an entity that processes > or > > facilitates the processing of information received from another entity in > a > > nonstandard format or containing nonstandard data content into standard > data > > elements or a standard transaction, or that receives a standard > transaction > > from another entity and processes or facilitates the processing of that > > information into nonstandard format or nonstandard data content for a > > receiving entity. Also see Part II, 45 CFR 160.103. > > > > Henry A Perretta > > HAPCO International, LLC > > 6302 Dunman Way > > Alexandria,VA, 22315 > > > > > ********************************************************************** > 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. > > > > ********************************************************************** > 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. > ********************************************************************** 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. ********************************************************************** 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.
