Bruce,
I would certainly not want to create another glossary if a WEDi glossy
exists. Perhaps we just need to add entries, etc.
Chris' assumption about my mission/intent ("...it was more a desire to nail
down consistent semantics within the context of
"addressing and routing" discussion...") is correct. Without such a common
and consistent semantic of the terms used, we'll be chasing our tails and
get wrapped around axles unnecessarily.
Who maintains the WEDi glossary; how does one obtain a copy of it; and how
does one request additional entries or modification to an existing one?
Rachel
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, February 13, 2002 12:02 PM
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: RE: Requirements Gathering - Information Flows
Chris --
I would suggest approval for additional or supplemental glossaries be
obtained before we expend a lot of effort to build and reference or use one
in conjunction with a Routing white paper. I know the Exec and/or the
Steering Committee addressed this issue before and we decided (among other
things) that:
1. A common white paper format should be adopted to facilitate a more
consistent presentation of the white papers. To that end, we may need to
adjust the initial format Peter has proposed -- but hopefully not much. To
be honest, Peter may have a better format than we have used for the other
white papers, but unless we are ready to rewrite all the others, we'll need
to use the existing format.
2. We would use a common glossary to avoid redundancy and/or to avoid
different definitions of the same terms. Even if the terms we would
include in a Routing glossary don't exist in the WEDI glossary -- they
could and probably will, as existing white papers are enhanced or
additional white papers are developed. To complicate the issue further, I
would assume the Routing white paper would use some terms that already
exist in the WEDI glossary -- and if so are you proposing we "re-define"
them in a Routing glossary or reference them in the WEDI glossary? Neither
option is really desirable if we try to have a WEDI glossary and a Routing
glossary.
I am sure Zon would be amenable to virtually any suggestion that improves
the quality or expands the use of the existing glossary and would suggest
we move in that direction -- unless there is a compelling reason to do
otherwise. If there is a compelling reason, I can and will support it --
but I don't know what it is.
What do other folks on this listserv think?
Thanks -- Bruce
"Christopher
J. Feahr, OD" To: [EMAIL PROTECTED],
[EMAIL PROTECTED]
<chris@optise cc: "WEDi/SNIP ID & Routing"
rv.com> <[EMAIL PROTECTED]>
Subject: RE: Requirements
Gathering -
02/12/2002 Information Flows
08:50 PM
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
