Kepa Zubeldia responded to Joe Barton on the WEDi Transactions Listserve on Friday, 09 November, 2001, in "Re: Provider Confusion: The Routing Problem, or What's my Name?"
But, if I am a provider, and a patient comes with an ID card that says that ACME insurance Payer ID is 1234567890, how do I know whether this claim goes through Clearinghouse A, Clearinghouse B or directly to ACME? Evidently, if I send it directly to ACME, I should have a password to access their system. Same problem for a payer. Let's say a payer wants to send 835 to all of its providers. How will the payer know which provider is connected through which clearinghouse so the files can be put in the correct queue? The provider ID does not answer the question of which is the route for this transaction to that provider as of today. This is related to the questions I asked Chris Feahr yesterday: why the heck should the provider (or payer) have to make decisions about which CH to go through to get hold of a particular payer? Or vice versa (payer to provider). Can't Clearinghouses do interconnects? If a payer or provider has to make all these decisions itself, why doesn't it just save itself the hassle and go direct - point to point? Then it might be useful to have a "central payor address/routing directory." But as we've seen discussed, there might not be incentives for anyone to put such a thing together. William J. Kammerer Novannet, LLC.
