HIPAA & CBA

[mal]

By October our plans will be required under the EDI regulations

to receive contributions and remittance information

electronically. A question that has recently arisen concerns

the interplay of the collective bargaining agreement with

the EDI regs.

Suppose the CBA says an employer must send all contributions

and reports in paper form to the custodian. Must the

plan still have the ability to receive this information

electronically? If the employer asks to send the information

electronically (in violation of the CBA) is the plan's only

recourse a grievance or 301 action? Can an employer

violate the CBA and still exercise its rights under the

EDI regs??

Any thoughts are appreciated.

[GBurns]

First beat senseless the person who drafted that CBA. Such rigidity was unnecessary and shortsighted.

I think that adhering to the EDI requirements would violate the CBA, Why not get a MOU from the Union accepting this minor change in delivery?

A violation of EDI has no bearing on the CBA and vice versa.

What sort of 301 action do you see as possible?

[mal]

So would it be your opinion that the HW plan

would be forced to accept the remittance report and

the contributions electronically (even though the

remainder of the monies and report would be sent

in hard copy to the custodian)?

The 301 action would be injunctive in nature

asking the court to force the employer to

follow its obligations under the CBA regardless

of HIPAA.

I do agree that the rights under HIPAA and the

obligations under the CBA seem to be mutually

exclusive of one another.

[GBurns]

I wish that you had posted this on the Health Plans Forum where you might have received more responses.

Why does this even apply to your company?

What says that you have to receive contributions etc electronically?

This sort of enrollment/participation information between employer, plan sponsor and service providers seems to be exempted.

[mal]

I didn't put it there because I was seeking the opinion

of those who work with or are familiar with collective

bargaining agreements.

My understanding is that it would apply to our

group under the EDI regs. Two of the covered

transactions are "benefit enrollment and maintenance"

and "health plan premium payment."

Hopefully I am just missing the boat and we can

continue with business as usual.