Mimi- These are exactly the types of issues your clearinghouse should be able to explain in detail. Also, for organizations whose vendor required the use of a clearinghouse for translation, these same issues are important. I know of at least one system vendor whose parent company owns a clearinghouse and which will require that providers use its clearinghouse for translation. The vendor will be outputting a proprietary non-standard format but its system today does not support all the required HIPAA data elements. It seems the clearinghouse has taken the position that situational data elements not required by the payer aren't required for HIPAA.
Providers need to decide for themselves the level of compliance that is acceptable to them, not their vendors and clearinghouses. Please see my comments below: -----Original Message----- From: Mimi Hart [mailto:HartAM@;crstlukes.com] To: WEDI SNIP Testing Subworkgroup List Thanks for all the responses to my original question.I have had a couple listservers ask for examples of my concerns, so here goes: Delivery related claims: PAT089 -Newborn Weight Not currently sent - per my reading of the IG - required on claims/encounters for delivery services/when pt's age less then 29 days. So does this mean the clearinghouse/payers are interpreting this as: Required on claims/encounters for delivery services ONLY IF WE NEED TO ADJUDICATE? <Marcallee - yes, lots of clearinghouses preface every situational data element with "required if required by the payer for adjudication and" so if the payer doesn't need it, they don't edit for it. Not HIPAA compliant but common nonetheless> All Claims: CLM09 -Release of Information Code Per my reading - required on every claim Not currently differentiating between just that we have a signature on file, and whether it is appropriate, restricted, etc. So does this mean the clearinghouse/payers are going to interpret the fact that we have a signature on file as an A - appropriate - and let it go at that? <Marcallee - they may be using a standard default or they might just be leaving it blank.> Thanks MIMI --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-testing as: [email protected] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
