Health Information Management

State group: Clearinghouses need improvement

HIPAA Weekly Advisor, March 1, 2004

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State group: Clearinghouses need improvement

Clearinghouses have had a hard time producing claims that comply with HIPAA's X12N 837 format, according to a group that represents health care providers in Wisconsin. In fact, many of them are taking HIPAA-compliant claims from providers and making them noncompliant, the HIPAA Collaborative of Wisconsin (HIPAA-COW) said at a January hearing of the Workgroup for Electronic Data Interchange (WEDI). In written testimony, HIPAA-COW recommended greater communication between clearinghouses and the payers and providers they serve. Clearinghouses also should not be able to deny an entire batch of claims simply one claim contains an error, the group said.

Read the group's testimony here: http://www.hipaacow.org/hipaacow/Docs/WEDITCSTestimony011604.doc

Based in Watertown, WI, the WEDI affiliate HIPAA-COW includes in its membership several state agencies, provider groups, and payers. The membership of Reston, VA-based WEDI consists of a mix of payers, providers, government agencies, and other stakeholders.



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