What is HIPAA EDI? From participation in a TCS Test session, I learned that it may impact every aspect of a covered entity, that there were many relationships between different kinds of out-side entities, and it entailed considerable technical development in a time when rapid change is occurring economically and politically, and technology wise, electronic data was becoming work flow. Many issues and concerns were raised among the test group. I have written a white paper to summarize the findings of the test group and it is available in the ShareHIPAA Files section.*
One of the issues was:
"One of the more basic issues of claims adjudication with HIPAA Electronic Data Interchange (EDI) transactions is the concept of “paperless” or electronic claims. The use of technology to use electronic data interchange to cause an event, instead of using technology to produce a document which causes an event, is a concept that is difficult for some to grasp."
Peter Barry has written a paper explaining how HIPAA EDI differs from the transaction per claim transactions. This concept is very important in understanding why 100s of claims can be rejected if just one data element is wrong or missing on one claim included in the transaction-set. Understanding this concept will enable you, if you are having problems with getting claims paid because you can't get the transaction-set accepted, to better negotiate how your HIPAA EDI is accepted with your trading partners.
Here is a what Peter Barry has to tell you about the attached paper**:
"I received a number of requests for a copy of the paper, "Batch versus Claim: What is the right span of action against an error found in a single health care claim?"
The requests were in the thread "Payer rejects entire 837 file..."
This paper derives from a presentation last November at the SNIP conference on claim errors.
Feel free to distribute the paper provided it is not changed. Let me know what you think is wrong, unclear, or missing from it. Thanks."
Peter
Peter Barry
Peter T Barry Company
Independent Consulting Health Care and Information Systems
(414) 732 5000
peterbarry@...
Suite 10
744 Wedge Drive
Naples Florida 34103
or
Ozaukee Bank Building
201 North Main Street
Thiensville Wisconsin 53092"
Thank you, Peter.
Regards,
Barbara McGowin, CPC
Executive Recruiting
HIT Recruiting
(843) 824-8537
mcgowins@...
Connecting Healthcare Organizations with People,
Products and Services to Achieve HIPAA Compliance.
P.S. Both documents mentioned in this email may be accessed from the files section of ShareHIPAA. To access the files section, go to the ShareHIPAA home page at http://health.groups.yahoo.com/group/ShareHIPAA , sign in with your Yahoo! ID and password and then select "Files" from the left column. Files are listed in alphabetical order (generally). Look for these:
* tcsicepp-final.doc
Msg #107
**HIPAA_Batch_vrs_Claim.pdf
Msg #177
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