Miriam, there are no optional fields - just "situational." And the "situation" for the taxonomy code is "*Required* when adjudication is known to be impacted by provider taxonomy code." The payer is probably telling you that it needs the taxonomy code to discern reimbursement rates based on specialty. Once it's told you that, you now know that "adjudication is known to be impacted by provider taxonomy code" - and now you're required to stick in the taxonomy code!
But you would think it would be easiest all around if the payer simply said (in its "companion" guide) that sometimes reimbursement is dependent on knowing the provider taxonomy code, and that the lowest applicable rate will be paid if it's missing. In most cases, the provider knows what those conditions are, and can omit the taxonomy in most - if not all - "situations." Because of the phrasing of the situational notes, I wouldn't lump this in the category of egregious special "needs" and one-off requirements that fill pages and pages of "companion" guides. But it is a hassle imposed on the provider which we all thought the addenda were taking care of by making the PRV situational everywhere. P.S. This issue might better belong on the Business Issues listserve rather than Testing. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Miriam Paramore" <[EMAIL PROTECTED]> To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> Sent: Friday, 28 February, 2003 09:08 AM Subject: Payers and Optional Fields 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 --- 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
