If we do address the auditing issue, am I safe in saying that our concern should be limited to making recommendations for keeping track of an (intact) interchange as it hops through intermediaries on the way to the receiver?
If so, usage of the TA1 (Interchange Acknowledgment), transaction set 997 (Functional Acknowledgment) and transaction set 242 (Data Status Tracking) are all within our purview. The 997 and TA1 are covered in the HIPAA IGs; the X12 242 transaction is used between intermediaries (e.g. VANs) to say what the disposition was of interchanges as they passed through interconnections. Once an interchange has been opened, tracking and auditing probably relies on application segments (perhaps the 837 Loop ID-1000), and thus is out of scope for this project. William J. Kammerer Novannet, LLC. +1 (614) 487-0320 -----Original Message----- From: Marcallee Jackson [mailto:[EMAIL PROTECTED]] Sent: Thursday, January 24, 2002 1:36 AM To: [EMAIL PROTECTED] Subject: RE: Whose name is it, anyway? Rachel- While it may not be important to the payer/receiver what path the claim takes, it is often important to the provider who might like to have some sort of record of where his claim was sent. Particularly if claims are being delayed by several days while they pass from trading partner to trading partner. Pull up a WebMD payer list and see if you can tell which payers they send direct and which they send through trading partners. I think most providers would appreciate an easy way to follow a claim's path. Perhaps important to remember is that most clearinghouses will translate every single claim that comes into their operation into an internal format before translating it yet again into an outbound format (which may or may not be standard). Since non-standard transactions = violation, it might not be so bad to know who might have altered content along the way. One other thing, I once experienced a situation where clearinghouse trading partners had a payer client switch clearinghouses from one to the other. Clearinghouse A won the contract over Clearinghouse B. Clearinghouse B updated their system and began to route the payer's claims to Clearinghouse A. Clearinghouse A, after testing and processing a production file, never made the final switch to automatically move the claims direct. Instead, their system sent claims to Clearinghouse B who sent them to Clearinghouse A and so the claims looped for almost a year until the auditors asked why there where no billables being sent to the participating payer. Now I've worked with lots of clearinghouses and I know that the best you can do is find the cleanest dirty shirt. While there where lots of errors made to allow this type of problem, these types of issues aren't that unusual. If there had been an element tracking the entire path of this transaction, it might have been caught much earlier. I love a good debate! Marcallee
