If there are payers out there who are "running eligibility on a separate system from their claims," then I don't know how we can treat real time as a "secondary issue." Right at the start, won't these payers demand some way to say eligibility requests go here, and claims go there? Or do these payers maintain a single EDI entry point which can do the culling and separation - passing inbound eligibility request functional groups on to a real-time process, while batching claims for the third-shift?
Should this "splitting" be the responsibility of the sender (say, the provider) or the receiver (payer)? If the sender, then he's responsible for getting the interchange to the appropriate "EDI Address" or portal for real-time vs. batch. Otherwise, if we agree the burden should be on the receiver, she has to have one portal and split transactions and route internally. My bias would have been to not put this burden on the sender (provider), as I had pleaded in Re: Batch vs. Real Time transactions (30 January) at http://www.mail-archive.com/routing%40wedi.org/msg00113.html. William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "David Frenkel" <[EMAIL PROTECTED]> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Tuesday, 02 April, 2002 05:46 PM Subject: RE: Are only 15 characters in the ISA receiver ID enough? William, I think you are making an assumption that may not be true in all organizations. Many large payers and Medicaid's run multiple systems that may physically separate claims from eligibility onto separate platforms. I think your assumption is there will be a single translator/communications gateway which is true most of the time. Since Highmark has been in this discussion, how do they currently receive claims and eligibility? At the X12 meetings in Seattle there was a presentation from a large payer that if my memory served me correctly, implied they were running eligibility on a separate system from their claims. I don't intend to downplay the importance of real time issues but maybe it can be a secondary issue for now. Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030
