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RE: 837 Medical Claims question
A bit of clarification to Leah's comments.
First, there are NO jail terms for any covered entity that may be not in
compliance with the HIPAA TCS requirements. Imprisonment is ONLY a penalty
for certain violations of the HIPAA privacy requirements.
Second, while monetary fines are a possibility, CMS will not be levying any
fines for some period of time. Rather, CMS has repeatedly stated that they
will enforce the HIPAA TCS requirements based on complaints received.
Furthermore, they will first investigate complaints and if the entity can
show good faith due diligence efforts to achieve compliance, no enforcement
action will be taken.
Rachel Foerster
Chief Executive Officer
Rachel Foerster & Associates, Ltd.
Voice: 847-872-8070
email:
-----Original Message-----
From: Leah Halpin [mailto:
Sent: Wednesday, July 30, 2003 10:00 AM
To: kbrasier2003
Subject: Re: [EDI-L] 837 Medical Claims question
Karen,
All 837 claims MUST BE HIPAA compliant per government regulation. There are
fines and jail terms for not following HIPAA guidelines. My suggestion
would be, since you have such a tremendously short deadline (Oct 16), is to
follow HIPAA guidelines strictly. This is a little difficult, as they are
somewhat confusing and HUGE, but, all people accepting 837's and sending
them must be able to send/receive HIPAA compliant documents per law. The
HIPAA guidelines are available at www.edi-wpc.com, free in .pdf format, for
a fee (hefty) in paper form. The 837 is two books, approx 800 pages. I
might also suggest joining the wedi-snip listservs to see if they can be of
any help, the url is http://www.wedi.org/. I wish you all the luck in the
world.
Leah
----- Original Message -----
From: kbrasier2003
To:
Sent: Wednesday, July 30, 2003 10:31 AM
Subject: [EDI-L] 837 Medical Claims question
I have been using EDI X12 for several years in business organizations
using po's, invoices, acknowledgements... I have just started working
on Medical claims... when i have asked our trading partners for specs
on what they are sending, 90% of the them are referring me to the 857
standard x12 format.... In the past, I have mapped each tp according
to their specs of what fields within what segments they were
sending... easy, precise.... what I am finding here is that nobody
seems to have their own specs, although some are choosing
different 'optional' segments.. I find myself having to look thru the
file they have sent, deciphering what fields are in what segments ...
Some tp's are even sending segments that according to the
837 'standard' mapping are 'not used'... ??? is this typical of
medical claims? I feel like there is something here I am
missing ... any suggestions? thanks much!
Karen
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