Unless an interchange is going through a pass-thru intermediary - a switch or a VAN - which delivers EDI for many entities, it probably really doesn't matter what's in the receiver field of the ISA, does it? If I deliver an interchange to Anthem, directly, doesn't it stand to reason that the interchange is somehow for none other than Anthem? Maybe Anthem will use the GS envelope for further routing, but would it even pay attention to the ISA receiver field?
But if the interchange is passed through an intermediary, such as a VAN or CH, clearly the immediate destination (the VAN or CH) will not be identified as the receiver on the ISA. The ISA receiver field probably should be that of the next entity to open the transaction set: this might be the payer (for a claim), but could just as well be a Re-pricer or Third Party Administrator - who I assume are not classified as "payers." Actually, the "real" payer (the insurance company behind a self-funded Employer plan) may never see standard transactions for a plan - is it correct in this case, then, to call the payer a "receiver"? William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "'Christopher J. Feahr, OD'" <[EMAIL PROTECTED]>; "'Dave Minch'" <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]> Sent: Friday, 05 April, 2002 06:43 PM Subject: RE: Are only 15 characters in the ISA receiver ID enough? Chris, This issue of defining who the "real" sender and receiver are was brought up early in this list's history. At that time I strongly recommended that a project glossary be developed so that, at least for discussion purposes here, we would have clear definitions of terms. Alas.... On the other hand, at that time I also did a rather thorough search of all of the HIPAA IGs and throughout all of them there is the consistent intent and use of the sender being either the provider or payer and the receiver being either the payer or provider. Nowhere in any of the HIPAA guides is there a explicit or implicit statement that the sender is just the next hop for the interchange. In other words, the provider and payer are the real trading partners for purposes of the HIPAA transactions, and intermediaries, whether clearinghouses or something else, are just that - an intermediary between the true end-point business partners. Perhaps it's useful to think about the U.S. Postal Service as a metaphor. The address on the envelope is always the end-point receiver, and not the next Post Office facility that the envelope may pass through. This is the model that the X12 interchange envelopes follow as well. Rachel Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http:/www.rfa-edi.com
