As a vendor who has tested with many payers directly, I have to agree with Jeff's assessment. While not all payers practice this type of deviation, I've seen it enough to know it's going to be a challenge to get it to stop. Being compliant and getting payment are totally separate issues in the "real world." I've certified my systems transactions so I know I can create HIPAA compliant files, but that has stopped the need for me to "tweak" my program to deviate from the rules of the IG due to certain companion guides' requirements.
__________________________________________ __________________________________ Richard J. MacCatherine Business Analyst Source Medical Solutions, Inc. 866 North Main Street Extension Wallingford, CT 06492 Direct: 203.284.7582 Fax: 203.284.7620 Email: [EMAIL PROTECTED] Web: www.sourcemed.net NOTICE: This communication may contain Protected Health Information, as defined by the Health Insurance Portability and Accountability Act, that is privileged, confidential or exempt from disclosure by federal or state law. If you are not the intended recipient, please note that any dissemination, distribution, or copying of this communication is strictly prohibited. Anyone who receives this message in error should notify the sender immediately by telephone or by e-mail and return the document in its original form. Thank you. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Thursday, June 12, 2003 8:50 AM To: WEDI SNIP Testing Subworkgroup List Subject: Re: your post on submitting clean transactions Kepa, As a provider, I'm seeing quite the opposite of what you say about clean transactions, here in the real world. Regardless of the fact that federal regulation require a payer to accept a clean X12 claim, they will do what works for them. Our local Medicare carrier has been pretty good at sticking with the IG, but the local Blues here came out with a 2" thick binder for the companion guide documents. Many of the segments are in absolute contradiction to the IG. When I called them on this, the response was simple...."follow the companion guide, or else the claims will get bounced on the front end edits. And since the front end edits are done before the claim enters our processing system, if its noncompliant, it doesn't get into the system." (Legal speak for "we never got your claim".) Never bothered to complain to CMS, as I need to get paid; not worry about the IG implementation. For most small providers, the 800 lb gorrilla leads the way. The software just winds up with a lot more conditional branches that it should have, but the cash flow continues. We've been sending X12 claims to Medicare and Blue Shield now since April, with no problems so far (knock on wood). Jeff Pinsky PTFILE Systems ________________________________________________________________ The best thing to hit the internet in years - Juno SpeedBand! Surf the web up to FIVE TIMES FASTER! Only $14.95/ month - visit www.juno.com to sign up today! --- 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
