This is the reason for my firm support of the CommerceDesk Model with a Front end adjudication acceptance included.
This model provides:
1) a step of health plan defined steps for the partner to follow in the implementation for each transaction (training, legal docs, reference materials, etc)
2) Validation of each transaction specific to the health plan
3) Adjudication acceptance
It does not get any better!
Julie
From: "Rachel Foerster" <[EMAIL PROTECTED]> Reply-To: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> Subject: RE: EDIFECS Trading Partner Enablement Date: Fri, 21 Mar 2003 21:44:48 -0600
While the EDIFECS tool may be "fabulous" as you assert, it is most certainly not the only game in town by which providers can have their claims transactions content validated at run time against a payer's companion documents. I am aware of at least one major healthcare clearinghouse/transaction processor that offers this capability now to all of the providers coming through its network for the major payers across the country.
What this means is that the providers do not have to worry about testing in some type of community enablement effort, but can begin sending their HIPAA claims to their major payers comfortable with the knowledge that their claim content will be validated against that payer's companion documents each and every time they transmit a claim to that payer.
Rachel
-----Original Message----- From: Julie Thompson [mailto:[EMAIL PROTECTED] Sent: Thursday, March 20, 2003 10:09 PM To: WEDI SNIP Testing Subworkgroup List Subject: EDIFECS Trading Partner Enablement
It is a fabulous tool and a serious opportunity for many health plans and other associations to validate provider's transaction against the health plans specific Companion Guides.
While the plans and/or other organization hold the product license for the EDIFECS web based Enablement Model, their trading partners may be invited to
validate their transaction on the Health Plans web site for FREE.
There is an additional option to hook into the Health Plan's "FRONT END" adjudication system(s) to assure that the providers' transaction are NOT only compliant, but the content may be adjudicate in the core systems as well.
NOW, this represents a solid testing strategy!
Anyone interested in seeing a demo, please contact me.
Julie A. Thompson 630-728-5580
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