William, I would agree with your comments about payers not being able to mandate 'certification' of providers. If it is not the law the providers have pretty strong political clout in the AHA and other organizations. The exception might be Medicaid and Medicare but even they are open to political pressure.
There has been plenty of discussion of certification but it comes back to the question whom is going to do the certification? Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030 -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Friday, April 19, 2002 1:07 PM To: WEDi/SNIP ID & Routing Subject: Supporting Certification in the Healthcare CPP Come to think of it, I'm actually gratified by all this buzz over IBM's patent (which possibly affects parts of ebXML's Collaboration Protocol Agreement). It means that it's now taken for granted by folks on this list that the WEDi/SNIP ID & Routing effort really will be based on ebXML technology and specifications, viz. the Registry and CPP -otherwise, no one would have been thrown into a tizzy over the issue! Continuing on: I've heard some grumbling that I'm herding this group off "on some quest for the ultimate, elegant solution, which is impossibly complex, beyond the comprehension of most people, not implementable in the foreseeable future, and also cures cancer." I like that. Since apparently I'm on a roll, I want to add even more complexity and gold-plating into the mix: There's been some discussion on the WEDI/SNIP Business Issues listserve, initiated by Kepa Zubeldia, talking about directories where you can look up to see if your partner is certified for certain transactions and scenarios, inter alia. See http://www.claredi.com/ and select "directory." This just serves to remind me that we need to discuss supporting HIPAA transaction certification in the Healthcare CPP. I definitely think certification can be of real value, but I guess I just want to ensure that certification is not used as an excuse by payers to put even more hurdles in the way of providers, causing unnecessary manual intervention or creating onerous enrollment requirements. If certification credentialization can be automated - i.e., the third-party certification service could digitally "sign" the credentials in the party's CPP (electronic trading partner profile), which could be examined automatically - then I might be a lot less concerned. Remember: eliminating all friction points which have to handled manually - with pairwise negotiation - is one of our biggest problems to solve! I would like to ask the folks writing the working paper describing the Elements of a Healthcare Collaboration-Protocol Profile (CPP) - Marcelee Jackson (who may not even know she was "volunteered" to work on this since she was absent from the Friday, 08 March teleconference), Dave Minch, Dick Brooks and Chris Feahr - to add certification credential verification to their list of requirements. I'm of the (perhaps minority) opinion that payers can't mandate certification of providers: if a standard claim comes into a payer, I can't help but think Administrative Simplification requires the payer to take it into adjudication. Testing is obviously important (for anyone with sense) - and I can see where not only does a payer want to ensure all his systems are "go," but would like to be "certified" to cover his "behind" in case a provider claims they tried to send standard transactions which were rejected out-of-hand by him. I don't expect providers have the same fear instilled - the worst that will happen to them is to have non-compliant standard transactions rejected, which they can then fix up and re-submit. It's not, like, y'know, a payer is going to stand up and complain to the government that this wretched little provider is screwing up in every way asking for his money! Nobody says the health plan has to "debug" the provider's non-compliant transactions: all the 997 has to do is report the first X12 syntax error encountered and reject the entire transaction set, or all the 824 (when we get one) has to do is report the first problem inconsistent with HIPAA, and refuse the transaction. There should be no back and forth "debugging" (on the phone), as long as the 997 and 824 are used correctly. William J. Kammerer Novannet, LLC. +1 (614) 487-0320
