When the WEDI/SNIP Business Issues management team created the ID & Routing SIG, I can't help but feel that they certainly understood where this project would head. The Business Case for the development of EDI Address Specifications was succinctly stated in "EDI Address: Business Case & Requirements" (Draft Document 6320), available at http://www.novannet.com/wedi/. See section 1.0, Business Case for Development of EDI Address Specifications:
Health care information operates in a many-to-many communications environment, involving tens of thousands of payers and hundreds of thousands of health care providers, as well as clearinghouses, network operators, and other participants, where every doctor, hospital, payer, and other participant potentially communicates with any other participant. EDI based solely on interlocking bilateral arrangements is too limiting. The requirement is for an addressing structure that is standard. EDI Addresses are essential for equal participation. They are a part of giving every participant, especially providers, the ability to receive transactions without having to poll multiple possible senders. The CPP Electronic Partner Profile grew out of the desire to have not only a machine-readable representation of EDI Addresses, as the project document originally envisioned, but also any other kind of common characteristics shared between partners (e.g., certificates, "companion" guides, certification credentials, supported transactions, etc.). Enabling the payer-centric mailbox model to go away is clearly the goal BI management had in mind for this project. It's obviously what the co-chairs of this group signed up for. And we're on our way to doing just that, undaunted by schoolyard taunts. 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: Friday, 14 June, 2002 06:23 PM Subject: RE: The payer centric model And round and round the mulberry bush we go! Making the payer-centric mailbox model go away or even enabling it to go away is not the objective of this group. Rachel Rachel Foerster Rachel Foerster & Associates, Ltd. Phone: 847-872-8070 -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Thursday, June 13, 2002 12:29 PM To: WEDi/SNIP ID & Routing Subject: The payer centric model Payers are required to use standard transactions if the provider requests that they do so. Somehow the messages have to be gotten to the provider. In the typical supply-chain scenario using VANs and interconnects, the sender merely "pushes" the interchange to his VAN. Then the sender's VAN itself will worry about delivering it to the receiver's mailbox (if coincidentally subscribed to the same VAN), to another VAN to which the receiver is subscribed, or even directly to the receiver (using a "push" model) if the receiver has arranged that service with his VAN. It's not the sender's (the payer in our case) problem to arrange mailboxing for the receiver. Quite a bit of time, trouble and money can be saved if each payer didn't think it had to "play" VAN. And it certainly shouldn't be the problem of the receiver (the provider in our case) to go traipsing off to 20 or 30 payer websites to retrieve standard transactions, going through each payer's notion of a logon process and mailbox retrieval. It makes sense to learn that process for your one and only VAN or clearinghouse - but it hardly contributes anything to administrative simplification for the provider to have to repeat that process for every payer with whom he expects to exchange standard transactions. In a lot of ways, the payer-centric way of doing e-business reminds me of the DDE conundrum, whereby each payer persists in expecting every provider to learn the intricacies of his own eligibility web page rather than merely supporting the 270/271 standard transactions in a first-class manner as required by the TCS rule. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320
