Miriam,
I hate to burst your bubble, but there have never
been standards. Our mindset has always been that these are
guides, which in turn are subject to interpretation.
----- Original Message -----
Sent: Friday, February 28, 2003 7:14
AM
Subject: RE: Payers and Optional
Fields
Thanks to all responses. Yesterday HAWK put on a testing
seminar here in
Louisville. One of the providers brought up this
specific example and said
"the standard is not a standard". You are
all correct that I incorrectly
used the word optional.
Bottom line,
if payers can require something for adjudiation (as
situational), then
there is no standard across payers. Right? This makes
our payer
data requirements cross reference much harder (a HAWK
project).
Disappointed...
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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-----Original
Message-----
From: Kepa Zubeldia
[mailto:[EMAIL PROTECTED]
Sent: Friday, February 28, 2003 10:06
AM
To: Miriam Paramore; WEDI SNIP Transactions Workgroup List; WEDI
SNIP
Testing Subworkgroup List
Subject: Re: Payers and Optional
Fields
Miriam,
The content of the transaction is under the
control of the submitter as long
as the submitter is complying with the
implementation guide. The theory is
that a payer cannot say that they
will not "accept" something that is valid
in the guide, or that they
"require" something the guide does not require
(including situational
requirements). That is the HIPAA theory.
The reality, at least today,
is different. Will the reality change after
October 16?
Maybe... But as of today, a payer that has filed for the
ASCA
extension, or small health plans that did not need to file for the
ASCA
extension, do not need to be compliant with HIPAA yet, so they
can
superimpose their own requirements. Perhaps that will change in
October.
At
least it "should" change. Or is it "must" change?
:-)
As for the Taxonomy code, if the payer says "I need the taxonomy
code
because
it impacts my adjudication system" then the provider MUST
send it because
that is what the implementation guides (Addenda) now
require.
Kepa Zubeldia
Claredi
On Friday 28
February 2003 07:08 am, Miriam Paramore wrote:
> 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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strictly prohibited.
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