A number of friction points have to be eliminated if we are to automatically "hook up" players in healthcare EDI. Unsolicited transactions from providers to payers (or even Payer-to-Payer, in the COB Model) would have to be supported without onerous up-front enrollment and coordination if our dreams of frictionless HIPAA e-commerce are to be realized. The discussion of companion guides arose out of the original thread entitled "Non-participating/out of network providers." Heretofore, the lack of standard transactions may have been one of the primary reasons providers did not electronically engage infrequently encountered payers - as opposed to vague and unspecified "financial reasons."
Now that standard transactions are available, one-off implementation guides are no longer an impediment to the free exchange of healthcare administrative transactions - that is, unless these "companion" guides get out of hand. As I've amply demonstrated, this is starting to happen: if each payer insists on arbitrarily changing the syntax and meaning of the HIPAA standard transactions through their "companion" guides (as CMS has done), there may be less point in removing the other barriers to exchanging transactions (e.g., paper enrollment). Companion guides were meant to assist partners so they could understand what pieces of information you are going to extract from the standard transactions and how they would be used in adjudication. I don't even think there's a "fine line" between "we will use the tax ID in preference to the DUNS for identifying providers" or "all amounts are expected to be in U.S. Dollars" - (carefully phrased semantic usages) - and wholesale rewrites of the HIPAA IG syntax rules. The former can probably be handled quite elegantly, for example, by the sender always including the Tax ID and DUNS, if available - as recipients can't demand that information they don't need be excluded. Unfortunately, changing the syntax usages requires separate maps or similar gymnastics for each partner. There's no need to bring this issue up on the Transactions listserve unless Paul Weber or others here fear that the purpose of companion guides is widely misunderstood. Our CPP electronic partner profile can support companion guides; left to determine is just how automated we can make that support. Since (well thought out and HIPAA compliant) companion guides are part of the process of setting up new partners, discussion of them is obviously relevant to our goal of using the CPP to automatically configure partner profile information. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Paul Weber" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, 03 July, 2002 01:35 PM Subject: RE: The use of Supplemental IG's Have to agree with Rachel. Please move this discussion elsewhere where we can get more folks involved. Perhaps "transactions"? ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Wednesday, 03 July, 2002 12:18 PM Subject: RE: The use of Supplemental IG's Please excuse my confusion here, but I don't see how the use of companion guides is related to the challenges of addressing and routing. Are we getting off on a non-essential tangent to the primary goal of this group? Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http://www.rfa-edi.com -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Tuesday, July 02, 2002 3:20 PM To: WEDi/SNIP ID & Routing Subject: Re: The use of Supplemental IG's Just out of curiosity, I went to the CMS web site to see if there were any Program Memos or Transmittals that had stuff about restricting inbound delimiters Sure enough, one of the first I picked out, Transmittal B-01-71 of NOVEMBER 8, 2001, says incoming 837 Professional transactions must utilize delimiters from the following list: >, *, ~, ^, |, and: - exactly the situation I was bemoaning! What if another payer wants me to use the group, record and unit separators (hex 0x1D, 0x1E and 0x1F) only? Arbitrary special conditions for every payer! - precisely the problem standard transactions were meant to take care of! To top it off, I see where it also says Currency code (CUR02) must equal 'USA' - I take this to mean that CMS wants all amounts in U.S. Dollars, even if the billing provider is Canadian, for example. But this can't possibly make any sense since the currency code must be one of the internationally recognized codes from ISO 4217. "USA" is not among them - "USD" is the symbol for the U.S. Dollar. So would I have to make a special exception in my mapping for just CMS in order to use an invalid currency code - because that's "just the way they do it." My data wouldn't even make it past a halfway self-respecting compliance analyzer using CMS' made-up codes. Or perhaps it was a typo? I have no problem with a companion guide that says what the payer is going to use from the particular standard transaction. But to reinvent the X12 and HIPAA IG syntax rules wholesale, as CMS is doing here, is clearly prohibited by the HIPAA TCS rule. I wouldn't be surprised if this kind of stuff becomes epidemic, and we're back to where we started from: one-off payer-specific IGs. For the purposes of our project, let's assume by October 2004 that we'll truly have standard IGs - and payers abiding by them! William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
