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Re: 10,000 Limit on INS segment in HIPAA 834

From: "Vasava Krishnamoorthy" <vasava.krishnamoorthy@...>
Date: Fri Sep 27, 2002  1:50 pm
Subject: Re: 10,000 Limit on INS segment in HIPAA 834
David, I guess, William given enough info in the self-insured plans.

William and Rachel, thank you for your responses.

I am looking at this more from technical point of view, a standard way
of communicating with these external
entities(payer/provider/insurance/ savings plan administrator). There
a different set of people looking at HIPAA from the business side of
it and will come to us (technical folks) later. I was told, we are
not "required" to send 834s yet. The current effort is a step towards
standardizing they way of communicating with our external entities.

Yes, we did contact our external entity to see whether thay can accept
more than 10,000 and waiting for their answer.
In one of our conversations, they told us that all the inbound 834s
they receive are first processed through a software which check for
HIPAA compliance. Then, the data is loaded into their system. So, I
guessing their answer is going to be a "no". I may have to write a
routine to split.

I am used to Supply-chain trading partners, we give IG or we get IG
with specific segments, elements and qualifiers to use and the job is
done.
I am new to HR/EDI and it is a different. For example, one of the
entity gave us their IG. All it had was "Download the IG from
www.wpc-edi.com and send us 834 document". After a bunch of emails
going back and forth, they gave us little more detail. Which was one
elements in GS and REF segments and said fill the rest as per the
standard and they can handle it. Luckly, we had IG from other
entities, which we figure out what needs to be sent.

Anyway, thanks for your help.
Moorthy

--- In EDI-L@y..., "William J. Kammerer" <wkammerer@n...> wrote:
> David:
>
> What are you fishing for? Let's assume, as you seem to be, that
Moorthy
> is talking about Bristol-Myers Squibb. Even if Bristol-Myers Squibb
has
> a self-insured health plan, its role as employer is unaffected.
> Bristol-Myers Squibb (the employer) is not a covered entity, and
HIPAA
> does not mandate that it use the 834. On the other hand, its
> self-funded ERISA plan, if any, is "covered"; but more likely than
not,
> any such plan is administered by a covered entity (say, an insurer),
for
> whom there's no doubt the standard 834 must be supported.
>
> In any event, Moorthy was talking about "sending" the 834 -
something
> that makes sense only for Bristol-Myers Squibb - the employer - to
do. I
> suppose it's possible that a self-funded plan might be administered
> in-house (talk about managing core competencies!), and it could
appear
> that a "hybrid" entity (i.e., a non-healthcare organization which
has a
> self-funded plan) might have to "talk to itself" with the 834 when
> enrolling employees. This seems like a marginal issue at best, and
you
> could go on day after day "nickel and diming" Moorthy to dish out
more
> information a dribble at a time.
>
> The point of requiring self-insured plans to support the HIPAA
standard
> transactions was so all the providers out there could just have one
> standard format to deal with when using administrative transactions
> (like claims). If self-insured plans could refuse to accept
standard
> transactions from providers by simply saying they aren't insurance
> companies, it would certainly gum up the works for administrative
> simplification.
>
> My advice still stands: instead of screwing around with Gentran or
> special code to make "split" enrollments, why doesn't Moorthy simply
> call the insurance company and see if it will take more than 10,000
INS
> loops? Sounds like a cheaper solution.
>
> William J. Kammerer
> Novannet, LLC.
> Columbus, US-OH 43221-3859
> +1 (614) 487-0320
>
> ----- Original Message -----
> From: "David Frenkel" <gefeg@a...>
> To: "'EDI-L Mailing List'" <EDI-L@y...>
> Sent: Thursday, 26 September, 2002 12:47 PM
> Subject: RE: [EDI-L] Re: 10,000 Limit on INS segment in HIPAA 834
>
>
> Moorthy,
> Are part of a self insured health plan at Bristol-Myers Squibb?
>
> Regards,
>
> David Frenkel
> Business Development
> GEFEG USA
> Global Leader in Ecommerce Tools
> www.gefeg.com
> 425-260-5030
>
> -----Original Message-----
> From: William J. Kammerer [mailto:wkammerer@n...]
> Sent: Thursday, September 26, 2002 9:11 AM
> To: EDI-L Mailing List
> Subject: Re: [EDI-L] Re: 10,000 Limit on INS segment in HIPAA 834
>
> Moorthy:
>
> I assume you meant to say "payers" instead of "providers" - the 834
> would be used to send employee enrollment information to your health
> insurance plans. An employer (even one who is a "covered entity,"
which
> you don't appear to be) is not obligated by HIPAA to use the 834 for
> enrollments. But the insurance company might demand you do so as a
> business decision, subject to mutual negotiation. Likewise, if you
both
> do decide to use the standard 834 transaction for transmitting
> enrollment information, you may mutually agree to allow more than
10,000
> INS loops - it's a matter between you and the payer.
>
> The law only mandates that insurance plans accept, as a minimum, the
> standard 834 transaction set. It imposes no obligations on you, the
> employer, to use it exactly as written in the IG.
>
> William J. Kammerer
> Novannet, LLC.
> Columbus, US-OH 43221-3859
> +1 (614) 487-0320
>
> ----- Original Message -----
> From: "akmoorthy" <vasava.krishnamoorthy@b...>
> To: <EDI-L@y...>
> Sent: Thursday, 26 September, 2002 09:36 AM
> Subject: [EDI-L] Re: 10,000 Limit on INS segment in HIPAA 834
>
>
> David,
>
> My question is not a response to another comment.
>
> We are working sending 834 enrollment information to some of our
> providers. In HIPAA implementation guide for 834 enrollments the
Loop
> 2000 for INS, it says ">1". In the "Notes" for that segments it
says,
>
> "No more than 10,000 INS segments can occur in a single 834
> transaction. Multiple transaction with in a single interchange can
be
> used to transfer information on larger number of members."
>
> The IDOC we are mapping from, will have one Control record and
> potentially more than 10,000 employees enrollment information. We
> tried to force ST segment in Gentran mapper when the count is
reached
> a certain number. We are unable to do it. It looks like to create
> mulitple ST segments we need multiple EDI_DCs. We have to insert
> additional logic get the data split into mulitple sets.
>
>
> Moorthy
>
> ----- Original Message -----
> From: "David Frenkel" <gefeg@a...>
> To: <EDI-L@y...>
> Sent: Wednesday, 25 September, 2002 06:46 PM
> Subject: RE: [EDI-L] 10,000 Limit on INS segment in HIPAA 834
>
>
> Moorthy,
> Your question seems to be a response to another comment. Could you
> clarify?
> The 834 is for enrollment information.
>
> Regards,
>
>
> David Frenkel
> Business Development
> GEFEG USA
> Global Leader in Ecommerce Tools
> www.gefeg.com
> 425-260-5030
>
> -----Original Message-----
> From: akmoorthy [mailto:vasava.krishnamoorthy@b...]
> Sent: Wednesday, September 25, 2002 3:34 PM
> To: EDI-L@y...
> Subject: [EDI-L] 10,000 Limit on INS segment in HIPAA 834
>
>
> Does anyone know, why there is a 10,000 limit on number of INS
> Segments in HIPAA 834 document? It doesn't make sense to add
> additional logic to split the file into multiple sets in an
> interchange.
>
> Thank you,
> Moorthy




 
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