Many of the companion guides are not "frivolous" they are the needed information for the adjudication systems to pay a claim electronically. Until there is a shift in the payer community to change the adjudication systems to only need the required data in an x12 837 and to be able deal with all of the possible values in the IG(s) there will be differences across the implementations. The reality of the situation is that with the transaction rules in place the variances between payer specific mandatory elements have become smaller than the variances with legacy formats. Some plans are changing their systems to allow for all possible values in an X12 837 to be acceptable for processing a claim. The providers also need to move towards be able to provide all of the information in a X12 837. These issues will work themselves out with time. Healthcare has successfully implemented electronic claims in the past and that system is much more fragmented than the HIPAA required system everyone is implementing now.
Dave Lounsberry Translation Systems Analyst BCBSNE -----Original Message----- From: Kepa Zubeldia [mailto:[EMAIL PROTECTED] Sent: Thursday, June 12, 2003 10:08 AM To: WEDI SNIP Testing Subworkgroup List Subject: Re: your post on submitting clean transactions Jeff, You ought to complain about this! The problem is that if nobody complains, it will never get fixed. Providers need to start a "revolt" against these frivolous companion guide requirements. The fragmentation of the standards into "custom" versions is probably one of the biggest threats that HIPAA has, and one of the many reasons why the implementation is going so slow. Kepa On Thursday 12 June 2003 06:49 am, [EMAIL PROTECTED] wrote: > 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 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 �� �� �b�� ��h���*.j���� �&�v+'�٨u�ڵ�S��b�ˬ�*'���+%��lz����~�ޭ�kzǧ��^�'�����v+�v楥��ȩj{ljw]�z-�� �ƫ�\�z�ޱ������,��aya [EMAIL PROTECTED]&[EMAIL PROTECTED]"�.z�ڵ�ڱ歆�i��'�� v*+��ki�"�Ӆ� �+-����h�Wg��ǝ~�ܢi��Ț�f���b� n��,z�+v+ ��"�z ��������ݢ�k�ۜ�Ƨvǫ�' �8^ɩl��ޞ�b�קu�m�����Z���韢�^��'jWb��+y鞞�(��鮇Ȩ��\�i��'�*'j֧�ئy�.j����ޞ�r���r��y�h��b��-�x��܆+ޙ��j�!����d�{.n�+�������+%��`��-��n�+���R{.n�+�������m��칻 �&���b��(�ǧu��jy �����^j��yحz�b� y�:װ���l��b��*.�睶�����r��y��ʋ�r��z{^���i�kz�"�z-��jg���^i�kz�,�� �&�v�-��b��ey� �ǭ��n�+���R{.n�+�������m��칻 �&���b��
