3/18/02 I have been convinced by the erstwhile Mr. Kammerer to participate in the WEDI/SNIP EDI addresses and TPA discovery projects, and to bring the perspective of the vertical market software developer.
I am a software developer, currently focused on the healthcare provider's desktop, specifically the desktops of the 300K+ or so small healthcare providers who may want or need to do something to be in compliance with the mandates of the 1996 HIPAA. I have been working with ANSI and EDIFACT EDI since 1983/1984 or so, and once I, too, held to the "dream" of electronic buisness without the need for bilateral Trading Partner agreements. I think I finally let that dream die in about 1995, when I had encountered just one too many variations in implementation standards for the most common of business documents (POs, Invoices). Having browsed the archives for the last month worth's of postings, I notice that a great deal of focus is being placed on the ANSI EDI requirements of the 1996 HIPAA - even though the one-year extension on implementation recently enacted by our Congress puts the "drop dead" date out to October, 2003. If we assume that the focus here is going to be on the implementation of the HIPAA-mandated document standards, the dream is rising from the dead: Since everyone will use the same implementations, all we really need is EDI addresses and which transaction sets and implementation version(s) is(are) supported. (More on these versions in a minute or so). As a consultant and developer, here is what I would like to do: Similar to the NIST "whois" web site (identify the owner of an internet domain name), I would like to be able to look up a plan (payer) by some publically available number, and ask for a list of transaction sets and implementations supported, as well as Interchange Identifier, Functional Group Identifier, preferred (or acceptable) delimiter characters, and routing (VAN, direct dial phone number, FTP site). The plan ID would seem to be the national payer ID, but those are not ready yet. However, there is NAIC for insurance firms; and AM Best Co. publishes the DUNS number for insurance companies. My "request" could be .. <SEND ME INFO FOR> DUNS|NAIC|NPID 1234567890 This can be done under control of an application program, permitting developer to provide "inquiry" to a user -as in, "Does this payer provide realtime eligibility checking? (See the X092 HIPAA specifications for more on real-time vs. batch eligibility checking). Michael Mattias Tal Systems, Inc. Racine WI [EMAIL PROTECTED]
