Chris: (1) I don't really think it matters who the sender (ISA06) is identified as, whether the actual doctor (or clinic) or the business agent (billing service?). The sender ID in the ISA is probably not going to be used in any adjudication decision. It's definitely the ID of the route to which the payer would return technical acknowledgments like the 997 and the 824. But is it the ID to which 835s are sent?
Regardless whether the standard claim was generated in the clinic's business office or by the Business agent (or Clearinghouse) a *consistent* sender ID should probably be used. Note that in the scheme of things, it could end up that the provider's ID is an alias of the business agent's ID (in that routing information is identical in whatever global directory eventually exists, or in the CH or VAN routing tables). Rachel would probably insist ISA06 be the ID of the actual clinic or billing provider - and that the BA would only create a transaction specific to that clinic. But what's really wrong with the BA using his ID in ISA06? From what I'm gathering in these threads, it's common for BAs to bundle claims from multiple clinics to a single payer - so obviously any particular clinic's ID shouldn't be used as the sender; instead the sender (or submitter) would be the agent, and his ID would be used in ISA06. The agent would receive technical acknowledgements. But would the agent receive the 835? Maybe the payer, rather than having to worry about which BA handles which provider, would simply use the payee's (the provider's) ID in the ISA receiver field - ultimately, the provider's ID would point to none other than the route to the BA (aliasing), and the 835 would end up where it belongs! Does anyone know if loop 1000 in the 837 (see Chris' question 3) was meant to be used to determine whom the 835 is to be sent? (2) Assuming that any particular claim (837) is intended exclusively for a single payer, it would make sense that the payer's ID would be in the ISA receiver field (how would provider, using standard transactions, know otherwise?), though in reality, the route for that payer ID could deliver the message to the payer's agent. Some things Bob Poiesz has said: "[the] 837 allows for one transaction to contain claims for multiple payers," and "the 837 transaction is capable of containing claim information for many different payers," means the 837 would not go to a payer (before it was further munged). I would like to see some detailed scenarios here - can anyone help? (3) I don't understand Loop-1000. But I didn't go any further in reading it after I read "the submitter and receiver concepts are difficult to define accurately." I'm working a lot on the assumption that providers who chose to do standard transactions should not have to worry about putting any but the payer's ID (which they obtained from the patient's insurance card) in the receiver ID. It shouldn't be his problem to figure out who the payer's business agents are, if any. That's job of the VAN or CH. William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]> To: "WEDi/SNIP ID & Routing" <[EMAIL PROTECTED]> Sent: Thursday, 24 January, 2002 12:11 AM Subject: Time-out for terminology question(s) Thanks for the positive comments regarding the "drop-box" thing. I did just reread appendix A and B in the 837 IG, however, and I want to be sure that I'm thinking about the same specific concepts and identifiers you folks are talking about. So here are a couple question areas: 1. The outer wrapper on the "interchange" (ISA-IEA) contains the ID of the "sender" and the "receiver" for the interchange. In the case of an interchange full of claims coming straight from a doctor or clinic, would this be the ID of the doctor or clinic? If the doctor uses a business agent to create the interchange, then the sender is the agent, right? 2. The ISA receiver, however, would seem to always be the final target... in the case of "claim" interchange, it would always be the PAYOR... right? The same payor identified on all the individual claims, right? 3. So how does each claim's loop 1000 fit into this? The IG says 1000 should contain the "submitter" and the "receiver", but it seems to be duplicating other information in the ISA. Woudn't the "submitter" be the same for all claims within a single interchange... and also be the same entity who stuffed them into the ISA envelope? Thanks, Chris Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
