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Right on the money!
Our standard maps (representing the implementation
guides) have to be supplemented with "local" files that are specific to the
companion guide requirements of the clearinghouse, payer or FI. All of
these different flavors remind me of Baskins & Robbins :). I am
still wondering where the "simplification" is supposed to reside in this entire
process.
Frustration expressed here is my mine, not
representative of my organization etc..
----- Original Message -----
Sent: Thursday, June 12, 2003 6:00
AM
Subject: RE: your post on submitting
clean transactions
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,
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-----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
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