William,
I agree with your assessment that manual TPA's would render any
automated routing methodology moot. I had previously raised the
question as to why the TPA cannot be transitive like the COT?
Better yet, why not combine the COT with the TPA? Then the COT/TPA
assumes the Payer trusts the Clearinghouse or Repricer to ensure the
validity of the Provider (Each CE carries the trust from the previous
entity). Not being a legal person, I don't know if this would be
advisable or not.
There are Provider Credentialing services out there that will
substantiate the licensing of an individual provider, as well. I
believe the infrastructure exists today, although it is not coupled with
the electronic transaction processing, and most likely not well
supported by the electronic processing systems.
If we could define the methodology for verifying the identity of a CE
as part of the TPA process, then the TPA may be able to be automated.
I've always advocated, if a manual processing works then consider
automation. If it's broken and you automate - you exacerbate the
problem 10,000 times more often. So, is the current manual TPA process
working well enough that it is possible to introduce automation and
standards?
Have any of the larger payers moved to a Web Based TPA process?
Would a notary model like Thawte (www.thawte.com) is using for
certificates be acceptable, or overly complicated?
So many questions, so little time.
I believe Kepa has the appropriate approach to solving the lower level
routing issues, but now we need to walk that back into the business
process level and see what falls apart.
If business requirements dictate a TPA between CE's before routing can
occur, then we must address how TPA's can support our efforts to
automate routing.
Regards,
Ronald Bowron
