Rachel, I cannot find any reference in the implementation guides (I am currently studying the 276/277 transaction set) to the sender/receiver in an ISA refers to payer/provider or provider/payer. Please point out to me where in the guides it states that the ISA identifies payers and providers.
Thanks, Bob Huffman RealMed Corporation Indianapolis, Indiana -----Original Message----- From: Rachel Foerster [mailto:[EMAIL PROTECTED]] Sent: Thursday, April 11, 2002 11:23 AM To: [EMAIL PROTECTED] Subject: RE: Are only 15 characters in the ISA receiver ID enough? Ron, while I don't disagree with your comments in general, keep in mind that nowhere in the HIPAA guides is the ISA sender or receiver identified as any other party than the provider or the payer. Nothing in the guides, which is what the industry must use, indicates that the ISA sender or receiver identifies **the next entity in the delivery pipeline.** In some/many cases, the provider would not now the subsequent hops that their claim would hit before ending up at the intended receiver, i.e., the payer. This is one of the conundrums we're struggling with. co·nun·drum (k…-n¾n“dr…m) n. 1. A riddle in which a fanciful question is answered by a pun. 2. A paradoxical, insoluble, or difficult problem; a dilemma. Rachel -----Original Message----- From: Ronald Bowron [mailto:[EMAIL PROTECTED]] Sent: Tuesday, April 09, 2002 3:39 AM To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Subject: RE: Are only 15 characters in the ISA receiver ID enough? Rachel, You may recall that we had submitted definitions for ISA sender and ISA receiver that I thought were considered acceptable. The basic concept is that the sender is the entity responsible for creating the exchange and it's contents and the receiver is responsible to processing the contents of the exchange. So, if the contents of the entire exchange (ISA to IEA) will be processed entirely by the receiver, then yes the ISA receiver will most likely be the provider or payor. But in many cases, data will be sent to a clearinghouse for the expressed purpose of processing the contents within the ISA to IEA and the repackaging the contents for transport to the ultimate receivers. In these cases, the ISA sender is a provider, but the receiver is the clearinghouse. While it may seem logical for a provider to send an ISA/IEA for each payor to the clearinghouse, that could make managing the transmission cumbersome. Instead of one 10Mb transmission with a 997 response, they could end up with 100+ transmitted files and 100+ responses. This can make managing the EDI interface too complicated for the average system environment. Although, there are some valid arguments regarding the complexities associated with bundling transactions within a single ISA/IEA. The mistake we keep making with regards to the Post Office comparison is we leave out two very important concepts - the type of Stamp we place on the envelope and the mailbox we initially place the letter into. If you put a FedEx package in your U.S. post office box, would it be sent? You first must determine the routing service (U.S. Post Office, UPS, Fedx). The other attributes on the package or envelop are dictated by the service chosen. The U.S Post office expects all envelops to be filled out the same way, but FedEx and UPS use another labeling method (although with similar routing attributes). We cannot assume a single transport or exchange, just like all packages currently do not get sent via one mailing service. The we previous challenges we faced within the current healthcare industry was the potential number of possible exchanges (VANs, Clearinghouses, direct connects, etc.). Each of these must be considered as a potential delivery service that has their own exchange (stamps and labeling) methods. Fortunately the EDI/X12 standards requires all players to accept the same exchange format (ISA/IEA). To fulfill the proper analogy with the existing mailing services, I believe the ISA/IEA is more closely associated with the Return Address (Sender) and the Stamp or mailing method (Receiver) - if a problem occurs, the receiver knows where to return the package. The type of package is represented by the GS/GE and ST/SE segments (priority, ground/air, letter, box , etc.) and the final destination address is something evaluated by the receiving party (U.S. Post office) to determine how to route it internally until it can be delivered to it's final destination (transaction level address) so the details of the transaction can ultimately be processed by the receiver of the package. While it is difficult to build a complete correlation between physical mailing vs. electronic mailing of transactions, we cannot ignore the stamps and labels required by the mailing services. Regards, Ronald Bowron
