Maybe you've heard this one: Q: How many University of Chicago economists does it take to change a lightbulb? A: None, they let the Free Market take care of it.
Unlike global payer and provider directories - for which no one has yet figured out a viable business model - there are companies today who make money by moving interchanges around (given the receiver ID). They're called VANs - or switches - and I'm guessing they'd be happy to take your standard HIPAA transactions enveloped with an ISA and move them to the appropriate payers. If it were even conceivable that Dave Minch would be able to set up 1000 trading partner profiles and perform 1000 tests himself, then you would think a VAN would have much more incentive to do so. After all, many of the Daves of the world will flock to the VAN just to outsource this headache, and the VAN can amortize the costs of this horrendous maintenance task over many providers. Then Dave only has to worry about one connection - to the VAN. Yes, we know that VANs cost money, but the savings from using the standard HIPAA transactions should more than make up for it. It also stands to reason that the VAN charges will probably be less than they would be in Rachel's "supply-chain world," in that every payer (I surmise from the rules) must provide a *free* means for Dave, the provider (or his agent, the VAN), to electronically submit standard transactions. The VAN, in this case, would hunt down these *free* SMTP and FTP addresses of the payers, instead of Dave having to do so himself. Since this would be a push model (rather than the classic VAN pull model, requiring long term storage of the transactions until the receiver retrieved the transactions from a mailbox), the VAN's costs will be lower, and the savings can be passed on to Dave! Likewise, if the world is just, Dave is entitled by law to have a *free* means by which payer responses, in the form of standard transactions, are returned to him. In this case, Dave appears to the payer(s) as an SMTP or FTP address (i.e., Dave's provider IDs are equated to these physical addresses using the recommendations we develop in this Special Interest group), and can receive his responses pushed from the payer. Only in Dave's case, his SMTP or FTP server is really handled by the VAN on his behalf. Dave merely takes his sweet time to access all his payers' transactions from his mailbox at the VAN using the classic pull model. The savings (over the "supply-chain world" model) will not be as great on Dave's inbound side (because the of the longer term storage), but Dave will still be happy to pay the VAN to handle the messy business of maintaining the inbound SMTP or FTP traffic. There are no interconnect fees, because the VAN is bypassing other intermediaries to talk directly to the payer. Of course, the payer's *free* conduit could be maintained by an agent, but Dave and his VAN don't have to pay for that - that's the payer's problem! William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Dave Minch" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Cc: "Ross Hallberg" <[EMAIL PROTECTED]>; "Joe Fuchs" <[EMAIL PROTECTED]>; "Michael Smith" <[EMAIL PROTECTED]> Sent: Friday, 25 January, 2002 06:30 PM Subject: RE: Payer identification codes for 837I I can vouch for Kepa's comment regarding many payers. We are a relatively small Health System, but we have over 2000 payers in the insurance table of our largest provider. Even if I assume that each company has at least 1 alias, that still leaves over 1000 profiles. That means if I want to send directly to each payer, I need to negotiate 1000 TPAs, perform 1000 tests, set up 1000 trading profiles, and implement however many unique transports to deliver the claim payloads to the "first hop" recipients. And I'm just 1 provider (well, actually 15) -- think of how many of us are going to be knocking at the payer's doors. Are you guys ready??? Then I shall simply pray a whole lot that if any one of the links in this frighteningly fragile chain of mail carriers decides to change transports, methods, passwords, encrypting, etc. that they give us good advance notification, and that the information they communicate is accurate, and that they don't decide to change things at the last minute..... Mess?? you got that right! Lets see.... If I can average 3TPAs per day, and get them all set up for testing it should only take me 15 months to get all 1000 ready by 4/16/03. I guess I can just make it if I start tomorrow... Does any of this sound as absurd to anyone else as it does to me????? Dave Minch T&CS Project Manager John Muir / Mt. Diablo Health System Walnut Creek, CA (925) 941-2240
