I agree that the challenge before the industry is daunting. On the other hand, there is nothing in the law or the regulations that **requires** any integration of an EDI front-end system with the back-end application system. And actually, it would not be in violation of the law for an entity to take in the EDI transaction through a low-cost EDI system, print the data to paper and then process the transaction through their usual internal processes.
This approach doesn't deliver the benefits of reducing costs, but it is not any violation of the law. And for many, especially small organizations, this might be the most appropriate tactic for the near term. I'm not advocating this approach for all, but for some, it could be the more appropriate business decision to make at this time. Rachel Foerster -----Original Message----- From: Julie Thompson [mailto:[EMAIL PROTECTED]] Sent: Wednesday, December 04, 2002 7:47 PM To: WEDI SNIP Testing Subworkgroup List Subject: Re: Does one bad transaction spoil the whole transaction set? - used to be defining a health care claim within the context of the 837 implementation guide Good to hear from you Marcallee! By Federal Law, Medicare requires 837 compliance by October, 2003. If you are compliant with Medicare, why not all other payers? So the paper option has been pretty much eliminated. We are AGREE, the task at hand is more than DAUNTING, but here we go! Some implementation will go smooth as silk, others will take a while. IT Developers are familiar with lengthy, complicated testing processing and are well trained for these jobs. I am not so concerned about element by element validation, but by the last items on the list....integration. But this is a lengthy discussion. All trading partners are going to as much work done as they can in the short time left by October. Keep in the mind, the implementation will appear in waves, NOT just one fell swoop. This will be helpful. Julie A. Thompson From: "Marcallee Jackson" <[EMAIL PROTECTED]> Reply-To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> Subject: Re: Does one bad transaction spoil the whole transaction set? - used to be defining a health care claim within the context of the 837 implementation guide Date: Wed, 4 Dec 2002 17:17:50 -0800 This is not a clearinghouse issue to fix. What if the 300,000 claims are coming from an entity that is not a clearinghouse? What if it's 3000 files of 100 claims each with 1 problem? Very, very, very few submitters have front-end editing to ensure compliance, with HIPAA or payer specific requirements, so payers who accept direct transactions can expect to see errors in many of the transaction sets they receive. When it comes to real life production, hard-line approaches like this simply will not work. I think your clients might need to get ready to receive an awful lot of paper. I know of a good scanning solution if you think that might help ;). Marcallee -----Original Message----- From: Julie Thompson [mailto:[EMAIL PROTECTED]] Sent: Wednesday, December 04, 2002 4:57 PM To: WEDI SNIP Testing Subworkgroup List Subject: RE: Defining a health care claim within the context of the 837 implementation guide Isn't it the job of clearinghouses to fix these issues? A compliant transaction will use dummy or default values in order to achieve compliance. Yes, this is the plan for numberous BCBS across the U.S., including several of our clients. Julie A. Thompson Vice President, Concio From: "Marcallee Jackson" <[EMAIL PROTECTED]> Reply-To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> Subject: RE: Defining a health care claim within the context of the 837 implementation guide Date: Wed, 4 Dec 2002 16:46:17 -0800 Yeah well there're the FAQ's and then there's real life. You're going to have a hard time convincing many of us that Medicare intermediaries will be rejecting a batch (transaction set) of 300,000 claims (transactions) because claim # 299,996 is missing a zip code. Are you seeing this in real life implementations and if so, can you share the names of the carriers? --- 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
