I follow your reasoning, and agree as far as the example presented goes. I guess I am 
thinking of a specific case that I never could figure out the answer to. In this case, 
there were several layers of reporting activity above the adjudication and payment 
described. Ultimately, the electonic data was delivered by the health plan to Medicaid 
in an 837 format. I tentatively concluded that the entity was not a clearinghouse, and 
that none of the exchanges had the correct senders, recievers, and business purposes 
to be a HIPAA transaction. But it still puzzles me some, because if you only look at 
the origin and ultimate destination of the data you have either a claim or encounter 
data that has been translated, and I keep looking for the clearinghouse. 

Thanks for your (as always) thoughtful and helpful response

Susan Miller
[EMAIL PROTECTED]


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