[ Thursday, September 22, 2011 ]


Non-Privacy HIPAA: There seems to be a problem with the HIPAA transaction code for "eligibility." One of the initial components of HIPAA administrative simplification (where privacy and security reside) relates to what we sometimes call "transaction and code sets," where the industry was supposed to settle on specific forms for data and content in specific regularly-occurring "transactions" in healthcare. For example, every electronic claim for payment should be in the same form, no matter who is asking for payment or who is being asked to pay. Another standardized transaction is "eligibility," where a provider can ask an insurer to determine if a patient is eligible for benefits under a particular insurer. That's specifically true for Medicare; if a provider thinks a patient is a Medicare patient, they're supposed to be able to submit a standard electronic form to determine whether the patient is eligible or not.

Apparently, the system isn't working, or at least isn't working quickly enough. Some Senators are asking CMS to fix the system.

Jeff [5:32 PM]

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