Thanks, Rachel, for starting the ball rolling! You suggested we get some consensus of definitions of Transaction receiver, Transaction originator, Trading Partner, Intermediary, Clearinghouse, VAN, Provider and Payer.
Some definitions are already available in the WEDi HIPAA Glossary (01/20/2001), at http://www.wedi.org/public/articles/HIPAA_GLOSSARY.pdf: Value-Added Network (VAN): A vendor of EDI data communications and translation services. Health Care Clearinghouse: Under HIPAA, this is an entity that processes or facilitates the processing of information received from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction, or that receives a standard transaction from another entity and processes or facilitates the processing of that information into nonstandard format or nonstandard data content for a receiving entity. Also see Part II, 45 CFR 160.103: Health care clearinghouse means a public or private entity, including a billing service, repricing company, community health management information system or community health information system, and "value-added" networks and switches.... Health care provider means a provider of services (as defined in section 1861(u) of the Act, 42 U.S.C. 1395x(u)), a provider of medical or health services (as defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business. Payer: In health care, an entity that assumes the risk of paying for medical treatments. This can be an uninsured patient, a self-insured employer, a health plan, or an HMO. ...a trading partner is an external entity, such as a customer, that you do business with. So, (1) What's the difference between a VAN and a Clearinghouse if that "thing" is used only as an intermediary to funnel standard transactions between trading partners (e.g., providers and payers). (2) Are VANs and CHs intermediaries if they only pass-through standard transactions? Who else could be an intermediary? (3) Since VANs can perform services that insulate either trading partner from the vagaries of EDI, something that CHs do all the time, is the CH just a VAN specializing in Healthcare? (4) Is the CH ever considered a trading partner? - that seems to be a role played only by providers, payers and maybe banks. But, apparently, the CH can be the submitter or receiver (which weren't defined in the WEDi HIPAA Glossary); See Section 2.4 (Loop ID-1000) in the 837 Professional IG. William J. Kammerer Novannet, LLC.
