Clearinghouses could have taken care of trust issues between payers and
"unknown" or non-par providers long ago, but payers would not hear of
it. Kepa Zubeldia and Marcallee Jackson have written about an EDI
"Power of Attorney" concept which never gained any traction. This PoA
would allow CHs to
Greg,
The banking/brokerage industry is moving towards what is called Straight
Through Processing (STP) which in concept means all transactions will be
settled in what is called T+1 (today plus one business day). It is
painful to draw analogies to industries that embrace and run with
technology.
I have a question that is articulated in the below hypothetical:
Hypothetically, a payer has relationships with two clearinghouses to receive
claims and submit remits: CHA and CHB. A provider sends an 837-I through
CHB which, in turn submits to CHA to reach the payer. This process takes
place d
You have good points Mimi, maybe the banking industry is the better example.
If I go to New York and put my ATM card in the machine, I will get my money
because the Citibank machine is ultimately able to talk to my credit union
in Milwaukee. But this is done through an extremely complex network o
I understand your argument Greg...but isn't healthcare different in the
following:
1. Walmart uses EDI when it places an order with a supplier...who it
has talked to initially, probably had several meetings with, and
exchanged trading partner agreements and companion documents and
pricing. A supp
Wouldn't it stand to reason that the NM1 elements and
the ISA elements would be different? Two things would seem to suggest
that:
1. ISA
elements are not supposed to be used to carry any application
data.
2. ISA
receiver (at least) is commonly used to help in the routing and delivery thr
I completely disagree with the concept of an "open" portal. You are
discussing a strategy that violates basic security principal, and frankly is
not achievable today.
The reference to treating like paper was used. First of all, paper is
pre-screened by the post office before received into the p
We're not really worried about how folks do eligibilities in the short
term (pre-HIPAA).
But when H-day arrives, an 800 number is no substitute under HIPAA for
processing of eligibility inquiries: all payers must support the 270/271
Health Care Eligibility Benefit Inquiry and Response standard
tr
Hi Bruce,
Thanks for describing your procedures. Having procedures and processes to
deal with this potential scenario has been my point all along.not that
HIPAA requires a payer to process a claim from an unknown provider. It
appears to me that you do take the interchange into your electronic
Code 40 in NM108 specifies
receiver
Code 41 in NM108 specifies
submitter
Since these two terms can be somewhat ambiguous and
interpretable I very early on in this work group's efforts recommended that a
glossary be developed which provided specific unambiguous definitions to terms.
For
Mimi,
As alluded to by Bruce, the Blues have this process in place which
includes an 800 number for eligibility. State Medicaids are talking
about accepting out of state Medicaid claims; I think the details are
still in the works.
For out of network claims for the short term you may have to stic
Mimi, in the case of the blues, you would send your eligibility request to the
Iowa version of the blue plan, whomever that may be. That's part of the
"national" agreement the blues have through their interplan transaction
service.
--( Forwarded letter 1 follows )--
As pointed out by various folks, including Jan Root and Bob Poiesz , the
1000A (Submitter Name) and 1000B (Receiver Name) "audit trail" are of
limited usefulness - they most likely just reflect what's on the ISA.
And the ISA sender ID is used solely for reporting TA1 and 997
acknowledgements.
Det
Requesting clarification on this point..
One of your clients visits Iowa (vacation hotspot that it is)...a place
you don't have a large presence. He is injured and end up at one of my
hospitals. We don't have a trading partner agreement with you, as we
have no prior relationship. We can't send yo
Out on EDI-L, while discussing the open-EDI aspect of Healthcare - you
know: claims coming in from unknown or non-par providers - folks are
sharing their ailments as part of their stories. I won't do that here,
as I save those stories for my neighbors on the plane. But suffice it
to say, a recen
Thanks for your detailed answer, Michael.
Since I am not limited by someone elses software, I write my own, I have the
liberty and and the burden to solve this conclusively.
And with all the helpful answers in the last two days, I come up with the
following.
I will keep the ISA_06 element as my
We currently use login information at the ISA level. This is then cross
referenced with the system login/password that transmitted the interchange.
Interchange/ISA information is not forwarded to the applicable application.
Within the transactions we would use our business level IDs for the
submi
Hello Rachel,
What we will do is return a response to the submitter, depending on if it is
an unknown trading partner or an unknown provider within data from a known
trading partner. We will reject a transaction from an unknown trading partner.
We will front end deny an unknown provider.
We have
- Original Message -
From: Martin Scholl <[EMAIL PROTECTED]>
Subject: RE: Trading Partner ID
> Thanks for all the input.
> That helped a lot with the ISA/GS issue. But how about the loop 1000 , NM1_08
and NM1_09 with the 40/41 qualifier.
> What are you guys doing there usually? Again use
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