An Interesting Posting re: Clearinghouses somehow found its way onto the XML-EDI Group mailing list on 10 Jan 2002, at http://www.mail-archive.com/xmledi-group%40disa.org/msg01409.html.
...Today we are a company that processes 5 million claims with only about 10% electronic. Obviously we want to move to electronic submissions and in fact not only submissions but document exchange such as rosters, panels, remits, etc. Currently we are working with WebMD and other clearinghouses to capture the claims. However it is expensive somewhere from .29-.35 cents a transaction. So I am looking for realistic and cheaper alternatives. In addition, since WebMD performs editing we have no visibility to "dropped" transaction and this is an irritant to our providers. Ideally we would like to go direct and implement out own transaction engine or something similar. I have been told that providers only like to have one connection (that being a clearinghouse) and that they will not switch. So my question is --- IS that TRUE in your estimation. If so, what incentives have you seen used to go direct. And finally, what tools would you recommend. We are looking at bTrade, Cyclone Commerce and IP-Net. Because of the logging, mailboxing and non-repudiation, these seem to be a good fit with HIPPA but they too are very expensive and we would like to know if there are other alternatives. It sounds like the writer is with a claims processor. What's the difference between a claims processor and a Clearinghouse? Why would a provider have to hook up to both him and a clearinghouse? Wouldn't he already be the provider's intermediary? - in other words, I can see him hooking up with multiple CHs, but wouldn't a provider only have to link up with the claims processor? William J. Kammerer Novannet, LLC.
