great suggestion, Bruce. I did review the WEDI-SNIP glossary (just now) and I was not really thinking of any of those type terms for the "glossary" relating to this project. If I understood Rachel's mission here, it was more a desire to nail down consistent semantics within the context of "addressing and routing" discussion... so that we can use the terms (like submitter, interchange sender, etc.) in our paper with a list of explicit definitions in the same paper. I assume that we have enough networking industry awareness/experience that someone will point out definitions that are likely to be counterintuitive for our target audience. Here's the working list of terms I have so far:
EDI Address (names of sub-components?) Interchange Sender Interchange Receiver Interchange Route Transaction Sender Transaction Receiver Transport Agent (I forgot what I was thinking about here.. did someone use this term in an email??) Transport Protocol Authentication Protocol Dial-up Modem Settings (is there a better term for this? ..."baud", parity, flow control) Thanks, -Chris At 02:56 PM 2/12/02 -0500, [EMAIL PROTECTED] wrote: >I certainly support the development of a glossary. However, it is >important to know that WEDI SNIP already has a glossary and would suggest >that we update and use it (or reference it as needed) in any work products >that we may produce. It was created (and maintained) by Zon Owens -- but I >am sure he would appreciate any effort that expands or otherwise improves >the document. The use of one WEDI SNIP glossary is important because of >the overlap of terms among the many WEDI SNIP work products. > >Bruce > > > > > > > "William > J. > Kammerer" To: "WEDi/SNIP ID & > Routing" > <wkammerer@nov <[EMAIL PROTECTED]> > > annet.com> cc: > > Subject: RE: Requirements > Gathering - > 02/10/2002 Information > Flows > 12:32 > PM > > > > > > > > >I asked Chris Feahr Saturday: "So, who else's ID - other than the >payer's - would be in the ISA receiver field?" when "standard >transactions go from provider to payer, unmolested..." > >The exchange below, on HIPAAlive, from Ken Fody, answers the question. >A self-funded employer group health would be administered by a third >party (TPA) - claims and whatnot obviously would not be sent from the >provider to the payer (the employer), but to the TPA. Not only would >the payer in this case not want to have the stuff sent to it (after all, >it outsourced the grunt work to the TPA), but it probably isn't even >allowed to see the stuff since it isn't a HIPAA covered entity. > >When National Plan IDs materialize, then the plan could be identified >within the transaction set. But that plan ID could not be used in the >ISA, since there's no provision for qualifying the plan ID using the >allowable codes in the Interchange ID Qualifier. If the ISA were able >to address a plan ID, then routing of the interchange might be >accomplished automatically looking only at the ISA - using Kepa's DNS >directory, 987654321.PlanID.hipaa.net would ultimately point you to the >TPA (or the clearinghouse it uses). But in the meantime, I guess the >provider could place the ID (DUNS?) of the TPA in the ISA receiver >field. Are TPAs generally carriers themselves? - in that case their >NAICs would be available. > >All this points out, I believe, that we need a list of all "information >flows," starting with the simplest and progressing to the complicated >with TPAs and intermediaries. We could use Dave Minch's "nomenclature" >or formulae, e.g., > > Claim: provider ---> prov's CH ---> payer's CH ---> payer > Remittance: payer ---> prov's CH ---> provider > >When Chris volunteered to serve as keeper of the definitions, he added: >"please feel free (whole group) to throw any terms and definitions in my >direction as they occur to you." Now another has come up: do we need to >add sponsor to the glossary, in order to distinguish an employer who's a >payer from the employer paying insurance premiums to a Health Plan? > >William J. Kammerer >Novannet, LLC. >+1 (614) 487-0320 > >----- Original Message ----- >From: "Fody, Kenneth W." <[EMAIL PROTECTED]> >Sent: Friday, 08 February, 2002 05:32 PM >Subject: RE: TCS: Payer Name > > >Be cautious when you mention the NAIC (National Association of Insurance >Commissioners) number and payers. Only licensed carriers (ins. cos., >Blue Plans, and HMOs) have NAIC numbers. > >If the entity is not a licensed carrier (e.g. a TPA and/or group health >plan) then it will not have an NAIC number. How often does that happen? >Well, 50% of the people in this country have coverage through a >self-funded plan. Therefore, the number of folks presenting themselves >who have coverage processed by an entity that does not have an NAIC >number can be significant. > >With regarding to the National Payer ID, HHS has not even issued a draft >regulation yet. So the ultimate solution is not close to coming. > >Ken Fody >Independence Blue Cross > >-----Original Message----- >From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] >Sent: Wednesday, February 06, 2002 2:36 PM >To: HIPAAlive Discussion List >Subject: [hipaalive] RE: TCS: Payer Name > > >*** HIPAAlive! From Phoenix Health Systems/HIPAAdvisory.com *** > >Payers do have a NAIC number, which may be used. Some clearing houses >use our NAIC number to send claims to us. Some clearing houses use >their own number that they assign to us. We are waiting to see what the >government is going to assign to us. For information go to the >following site. http://aspe.hhs.gov/admnsimp/bannerid.htm > >Peggy Drake >Midwest Security > >-----Original Message----- >From: Catherine Lohmeier [mailto:[EMAIL PROTECTED]] >Sent: Wednesday, February 06, 2002 12:57 PM >To: HIPAAlive Discussion List >Subject: [hipaalive] RE: TCS: Payer Name > > >*** HIPAAlive! From Phoenix Health Systems/HIPAAdvisory.com *** > >Don't the payers have an id number for themselves? Often large complex >entities will have different payer id numbers which make it easier to >sort claims electronically. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
