Dave, Thanks. This is a good start to developing the various scenarios for which requirements must be developed for both EDI Addressing and Identifiers.
Rachel Rachel Foerster Rachel Foerster & Associates, Ltd. Phone: 847-872-8070 -----Original Message----- From: Dave Minch [mailto:[EMAIL PROTECTED]] Sent: Thursday, February 14, 2002 1:20 PM To: '[EMAIL PROTECTED]' Subject: RE: Requirements Gathering - Information Flows Here's a first cut at the paths we traverse today whether in paper form, phone, or electronically (I've probably missed a few - I'll keep checking): I'm going to use a coding scheme to make it quicker to do these: P=Provider A=pAyer (endpoint that creates the EOB) E=Employer T=Third party administrator R=Reviewer I=reprIcer C=Clearing House F=Fiscal intermediary (MediCal & Medicare) Benefits Eligibility: P-->F-->P (DDE & phone) P-->E-->P (phone) P-->T-->P (phone) P-->R-->A-->P (phone) P-->T-->E-->P (phone) P-->T-->A-->P (electronic) P-->T-->A-->T-->P (phone) P-->A-->P (phone & electronic) P-->C-->A-->C-->P (NCPDP transactions) P-->C-->T-->C-->P (NCPDP transactions) - this may also have a stop at A after T, but I can't determine that from the end result. Claims & RA: P-->F-->P (paper & electronic) P-->A-->P (paper & electronic) P-->T-->A-->E-->P (this may be P-->T-->A-->P \->E - I'm checking) (paper) P-->T-->A-->P (paper) P-->I-->A-->P (paper) P-->R-->I-->A-->P (paper) \->R P-->C-->F-->P (electronic) P-->C-->F-->C-->P (electronic) P-->C-->I-->C-->A-->C-->P (electronic) P-->C-->I-->C-->A-->C-->C-->P (electronic) P-->C-->T-->C-->A-->P (electronic claim, paper check & RA) P-->C-->A-->P (electronic claim, dropped to paper, paper check & RA) P-->C-->A-->P (electronic claim, paper check & RA) I've not included requests for information & status checking since these transactions are entirely manual now (excepting DDE with the FIs). As I'm looking at the functions of the review agency, it appears to me to be functionally the same as a third party administrator, so i'd assume for scenario building that T=R. Dave
