There is no such thing under the HIPAA standard implementations as an
optional field. Fields are:
Required - they must be sent always
Not Used - never sent
or Situational - sent if the Note in the implementation guide is true, not
sent if it is not true.
Under the addenda, in some (all?) of the claim guides, some (all?) of the
Taxonomy Codes were changed from Required to Situational with the Notes
saying things like "taxonomy is known to impact the adjudication of the
claim."
It sounds like Unisys is saying that the presence of the taxonomy code
impacts the adjudication of the claim. Now that you know that, you must
include it in your X12 transaction.
Sorry, but them's the breaks. Remember, HIPAA doesn't say anything about
how a payer conducts adjudication, just that they can't require any more
data than is supported in the guides (except of course that they can still
require attachments to pay claims, which aren't standardized yet)
Regards,
Laurance
"Miriam Paramore"
<[EMAIL PROTECTED] To: "WEDI SNIP Testing
Subworkgroup List" <[EMAIL PROTECTED]>
rvival.com> cc:
Subject: Payers and Optional
Fields
02/28/2003 09:08 AM
Please respond to
"Miriam Paramore"
This is probably the 100th time this has been asked... but bear with me.
Can a payer mandate that a provider put a certain value in an optional
field? Unisys has stated that it is requiring the taxonomy code in an
optional field, and will not pay the claim unless that optional field is
present.
I think this flies in the face of all things HIPAA standard. Isn't that
type of payer behavior expressly prohibited? Still, other payers felt that
they could get by with such a mandate as a "business rule" between trading
partners. Sounds like the dog is still getting wagged.
Best Regards,
Miriam J. Paramore
President & CEO
PCI: e-commerce for healthcare
9001 Shelbyville Road
iTRC Building
Louisville, KY 40222
502-429-8555
www.hipaasurvival.com
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