Bruce is on the mark when he says that many (I would even argue most) payers will not change their communication methods for HIPAA. There is no mandate to communicate the standard transactions in any particular manner, and mailboxes / secured bulletin boards are a perfectly acceptable manner in which to do business (and, I suspect, are by far the majority of how business is done today). All the regs mandate is that the payers cannot provide a lesser standard of service for any of the standard transactions. Ergo, if Bruce has a web-based or DDE method for providing eligibility information, he must employ the same near-real time timing to his batched 271 responses that he places in the mailbox.
These facts notwithstanding, there is still a need for Bruce to develop trading partner agreements with any legitimate provider who wants to use the standard transactions (he needs to establish his "mailbox" for that provider). The mutual CPPs, even if only printed and manually bound into a CPA-like document will be an excellent tool for expediting completion of Burce's trading agreement with that provider. I do have a further question for Bruce regarding development of trading agreements with other payers or third parties regarding COB claims. I'm trying to determine business requirements for payer-->payer CPP elements, and i'm completely in the dark on how you do it today, or how you plan on forwarding COBs from standard transactions. Dave Minch T&CS Project Manager John Muir / Mt. Diablo Health System Walnut Creek, CA (925) 941-2240 -----Original Message----- From: Bruce T LeGrand [mailto:[EMAIL PROTECTED]] Sent: Thursday, June 13, 2002 7:56 AM To: WEDi/SNIP ID & Routing Subject: Re: An Overview or Primer Document There is a common thread that keeps showing up in this discussion that I just cannot get past my reality check mechanism. Payers are required to support the standard transactions. They are not required to transmit them. Rather, in the instances where I have knowledge, Medicaid, Medicare and some Blues, they are going to put this data in a mail box and it is up to the provider to come and get it. Earlier there was a statement that my views a payer centric. I would argue that to follow the money, which is always the driving force in this dialogue, you will still end up with the payer. You want the money or the documentation, you do what the payer asks. ------------------( Forwarded letter 1 follows )-------------------- Date: Wed, 12 Jun 2002 11:45:34 -0400 To: WEDi/SNIP.ID.&.Routing[routing]@wedi.org.comp From: William.J.Kammerer[wkammerer]@novannet.com.comp Sender: [EMAIL PROTECTED] Subject: Re: An Overview or Primer Document Rachel: I hadn't really thought of that before: using the "critical timelines" to "sell" the concept of the Healthcare CPP and Registry. But now that you bring it up, the overview should definitely include verbiage on how the CPP especially facilitates the industry achieving these critical milestones. Would you mind doing that part of the overview? Obviously, most folks are going to continue using Clearinghouses to help them become HIPAA compliant, but as we've long said, the CPP and Registry are useful to intermediaries also. With Internet connections to clearinghouses and CMS, there are the new HIPAA mandated security rules to deal with which require signatures and encryption - and the CPP is the ideal mechanism for sharing and disseminating certificates. And though it's a given that payers have to support all the standard transactions, the CPP is critical for broadcasting the capabilities of individual providers, avoiding onerous manual interaction as standard transactions are brought online one at a time. Though I'm no big fan of *mandatory* certification, certification is still a good thing to have: the CPP is the most efficient means of conveying your certified capabilities to your partners. And though it could be left unsaid - after all the discussion of the last couple of weeks - I'll say it again: I think Open-EDI is going to spring on many payers as a surprise by H-day, and only an automated infrastructure provided by the CPP and the Registry will make that at all possible. Thanks again, William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Tuesday, 11 June, 2002 06:45 PM Subject: RE: An Overview or Primer Document No, William. I'm not at all suggesting that the CPP or any ebXML registry needs to address any filing submission under ASCA. That would be something that should be determined as part of a requirements analysis and management effort. I was identifying critical timelines by which the health care industry must comply with various aspects of HIPAA and trying to determine how any of these proposed working papers either facilitate the industry achieving these critical milestones and/or remove barriers and obstacles to the industry achieving these milestones. Rachel
