William, you might respond to this guy, it sounds like his organization is a health plan or a state organization. It would be worth clarifying where he is in the pecking order. There are organizations that will take pretty basic medical information from a medical visit and put it into somebody's 'standardized form including doing the various necessary 'coding'. This 'standardized form could be sent to a CH to be forwarded to a health plan. CH can also 'reformat' data but they usually get it in a more usable form. The way he is talking he sounds like a consultant who is unfamiliar with healthcare. Regards, Dave Frenkel ----- Original Message ----- From: William J. Kammerer <[EMAIL PROTECTED]> To: WEDi/SNIP ID & Routing <[EMAIL PROTECTED]> Sent: Monday, January 21, 2002 11:35 AM Subject: Interesting Posting re: Clearinghouses on XML-EDI Group
> 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. > >
