I know Mr. Kammerer did that just to provoke a response from me, and hopefully, mine will get through to the server this time.
I would submit that, at least with the company with whom I am familiar, we never accept unsolicited claims, electronic or paper, from providers with whom we have no established relationship. The blues are perhaps unique in this, since providers located outside of the service region do not send claims directly to that blue, but rather to the entity licensed to perform the same function in that state or region. We are not going to change the fact that we are fiscally responsible for paying claims to people actually licensed as providers and accredited by the state boards. Nor will we accept their assertion, by receiving a properly formatted claim, that they are who they say they are without some assurance, spelled contract, that we acknowledge their right to receive that payment. Nothing in your CPP will assure any auditor, paid paranoiacs that they are, of the validity of the relationship or the security thereof. Solve that problem, for free, then we've got some good groundwork. ------------------( Forwarded letter 1 follows )-------------------- Date: Tue, 28 May 2002 17:58:51 -0400 To: WEDi/SNIP.ID.&.Routing[routing]@wedi.org.comp From: William.J.Kammerer[wkammerer]@novannet.com.comp Sender: [EMAIL PROTECTED] Subject: TA1 responding to non-participating health care providers Just one more reminder - this time from the EDI-L mailing list - that we have to keep in the back of our mind something almost no other industry has wrestled with in EDI before: Unsolicited Transactions, à la Open-EDI, from non-participating providers. Payers will have to be prepared for taking in anything coming along from providers - if they would have taken paper before, they can't put roadblocks up discriminating against the equivalent Federally mandated HIPAA standard transactions! Not only will they have to make available an open portal for receiving electronic claims and eligibility inquiries (advertised in our Healthcare CPP Registry), but they will have to make sure their translators can accommodate ISA senders they've never seen before. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Tuesday, 28 May, 2002 01:32 PM Subject: RE: [EDI-L] TA1 On the other hand, the TA1 may become a useful/important ack in health care under HIPAA since it's entirely possible that a payer/health plan/insurance company could receive an unsolicited interchange containing health care claim transactions from non-participating health care providers. In this scenario, the translator won't know about the sender in advance, but the receiver needs to know it's received an interchange from an unknown sender and then take appropriate action. 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 -----Original Message----- From: DPR [mailto:[EMAIL PROTECTED]] Sent: Sunday, May 26, 2002 11:19 AM To: [EMAIL PROTECTED] Subject: [EDI-L] TA1 In my experience, I have never found anyone who wanted or cared about a TA1 segment. About all it says is roll call "I'm here'. There are quite a number of translators who don't even know what a TA1 is and choke if one gets through. So save your time and money and forget about the TA1. If the ISA/IEA is bad, you will never get a 997 in return. Dennis Robinson
