Are there any requirements that an EDI response to an 837 transaction be sent? Would a payer be non-compliant if it simply sent a printed EOMB to the submitter along with payment?
If the provider doesnt request an 835, the payer is compliant if it sends a paper EOB. Otherwise, the following EDI responses are appropriate, as applicable: 997 Functional Acknowledgment, 277 Health Claim Acknowledgment, 277 Unsolicited Health Claim Status, 277 Request for Additional Information, 999 Implementation Acknowledgment, and 824 Implementation Guide Reporting.
Related Questions
- Are there any requirements that an EDI response to an 837 transaction be sent? Would a payer be non-compliant if it simply sent a printed EOMB to the submitter along with payment?
- What are the HIPAA EDI transaction standards that impact Unums covered products?
- Why did Congress include the EDI transaction standards in the HIPAA regulation?