RE: Payers and Optional Fields

[Larry Watkins]

There are no such things as “optional” fields in the HIPAA IG’s, only “Required”, “Situational”, and “Not Used”.  On a “Situational” item, receivers of transactions (for claims that would be the payer) cannot require elements outside the scope of the specific situation described.  In the case of the taxonomy code, the situation is “required when necessary for adjudication”, so payers are allowed to require that element if it is necessary for adjudication.   Hope this helps, Larry Watkins Executive Vice President Claredi Corporation Office: (801) 444-0339 x204 Mobile: (770) 331-1898 Fax: (770) 419-5295 -----Original Message----- From: Miriam Paramore [mailto:[EMAIL PROTECTED] Sent: Friday, February 28, 2003 9:08 AM To: WEDI SNIP Testing Subworkgroup List 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 =========================================== This email contains confidential information intended only for the named addressee(s). Any use, distribution, copying or disclosure by any other person is strictly prohibited.   --- 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 --- 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