RE: Payor identification codes for 837I

[Ronald Bowron]

I'm curious,  why is this any different than DNS over TCP/IP?  The internet routes users to companies and WEB sites on a regular basis.  Are the business requirements for managing this "Trading Partner Directory" any different?  Wouldn't that be a good model to follow?   -RB  >>> "Christopher J. Feahr, OD" <[EMAIL PROTECTED]> 01/21/02 04:54PM >>> Rachel, I have considered this very argument... and yet the need remains. Numerous such needs have already been identified in vision care, alone, and I believe that several of the most-impacted businesses in our industry are simply going to have to "come up" with the start-up capital. While no one "wants" to pay transaction or license fees for this, that would seem to be the only model that would be self-sustaining. These could be very tiny fees spread across all providers and the central-entity could create a mechanism for collecting the fees. I agree that the task and the implied responsibilities are enormous... but then so is the return on the investment to the business who MUST HAVE accurate, real-time information to facilitate payment of claims. The challenge, I have found, is explaining the connection between funding such an enterprise and the bottom-lines of the investing healthcare businesses. I would think that such an enterprise would HAVE to be "not for profit, public-benefit" and that providers and payors would sit on the board and oversee its operation. Few would trust "the government" with such a task and few payor or provider organizations would be trusted because of potentially conflicting interests. TRUST and COMPETENCE would be the key characteristics of such an organization and PROFIT (in the normal sense) should NOT be part of its corporate mission. Not having trusted centralized agents within healthcare is going to severely limit the effectiveness of admin. simp. in the long run. I think we need to figure out a way to do this. In fact, I would personally be interested in managing/directing an enterprise like this for the vision industry, but I am encountering resistance to funding it... not surprising! Once the organization and IT structure is worked out... the distribution system, etc.. I would think that one system could handle many important "catalog" and "look up" tasks for healthcare. Regards, -Chris At 04:01 PM 1/21/02 -0600, Rachel Foerster wrote: >Chris, > >While I'm in complete agreement that such a database/directory that you >outlined below is needed and would be useful, the challenges for not only >establishing it, but maintaining and supporting it are great. Not the least >of these challenges is the cost to establish, support and maintain. Then the >issue of fees for access, etc. comes up, and I'm sure no one wants to pay >access fees. Other major challenges are just maintaining the accuracy of >such a database. > >Many years ago in the 1980's an enterprising couple of individuals created >the EDI Yellow Pages. It was a laudable effort and was ultimately sold to >either Faulkner & Grey or Thompson. This directory is no longer available. >The point here is that the information in this directory was often incorrect >or outdated or both and as a result, the directory became not usable nor >reliable. > >Rachel Foerster > >-----Original Message----- >From: Christopher J. Feahr, OD [ mailto:[EMAIL PROTECTED]] >Sent: Monday, January 21, 2002 2:13 PM >To: William J. Kammerer; WEDi/SNIP ID & Routing >Cc: [EMAIL PROTECTED] ; [EMAIL PROTECTED] >Subject: Re: Payor identification codes for 837I > > >Rouring and ID group: >I'm reposting this note (on " [EMAIL PROTECTED] ) that I sent to Kepa and Bob >Poiesz because it seems relevant to this discussion. I realize also that >Claredi is a private company and that there are probably other "testing and >certification" businesses on this listserv... I'm just fishing here for >thoughts from the T&C "community". > >In any case, it does seem that several important "central DB/directory" >needs exist in healthcare and that some profit or non-profit enterprise OR >the govt. will have to be entrusted with the job. Once such a structure is >in place... and trusted... I think we will find it immensely useful. Bill, >we don't have any "clearinghouses" in optometry-land... we are just now >waking up to the concept of "data standardization"! So the problem of >optometrists trying to figure out where to send claims and elig. queries is >very REAL and presently lies at the feet of the optometrists. >********************************* >Heres that other email/post: >Bob, >I agree 100% with your comments. Wouldn't such a centralized directory be >a good basis for a private business enterprise? Queries to and responses >from such a directory-entity would seem to be outside of HIPAA and could be >handled with XML, right? > >A few days ago, someone suggested that one of the "testing and >certification" businesses might be a likely/reasonable candidate for this >because they already have to be aware of this "routing" information for use >in the context of testing and cert. In Vision, we will be facing similar >"central directory" issues in the form of standard LOINC "answer lists" for >the new eyewear codes we are creating. It is my understanding that the >LOINC consortium will maintain the list of codes (the "questions"), but >that our industry will have to devise some reliable mechanism for >maintaining (and distributing) the "standard answer lists". > >The common thread here is "central directory structure needed" and "testing >and certification" seems to have overlapping needs for such a structure. > >(Kepa... is Claredi already thinking about solutions for any these >"directory" issues?) > >Thanks, >-Chris > >At 08:19 AM 1/21/02 -0500, [EMAIL PROTECTED] wrote: > > >This is a topic that I have discussed many times in the past. > > > >What we need is for more than just a national payer ID. There must be a > >database that is accessible by all payers and providers with more > >information than just the Name and ID. The additional information must > >include: > > > >Address > >Internet web site > >EDI email contact > >EDI email submission > >EDI contact phone number > >certificate/public key information for encryption > >supported transaction list (since not everyone must support all > >transactions, if they don't do that business) > > > >The same kind of information should be available on providers via their > >NPI. > > > >The ideal is for any sender/receiver to be able to find any receiver/sender > >in a database and perform all necessary tasks of security and validation to > >facilitate a seemless EDI interface, maybe even without the need for > >'signed' trading partner agreements. > > > >Of course, that is a long way off. > > > >Bob > > >At 12:01 PM 1/20/02 -0500, William J. Kammerer wrote: > >Maybe the payer could simply put the qualifier (e.g., NAIC or National > >Payer ID) and the number on the back of the insurance card the patient > >carries around: it could be squished in with the P.O. Box address for > >paper claim submissions! > > > >That ID would be used as the receiver ID in the ISA. The dream: any VAN > >or Clearinghouse worth its salt should be able to route the claim or > >eligibility inquiry safely, securely and reliably to the payer. Why > >should every optometrist in the land have to look up this stuff in the > >"central payor address/routing directory" - even if such a thing > >existed - when the CH or VAN could do it just as easily? > > > >And if the directory didn't exist, why couldn't the VAN or CH see that > >it doesn't recognize the NAIC code as belonging to one of its customers, > >and automatically set up the interconnect? The VAN or CH could query > >every other intermediary it knows about to see if they own a direct > >connection. Failing that, it could look up the code itself in the NAIC > >database (saving the provider the hassle of buying one) and manually > >resolve where to send the transaction electronically, even if it means > >calling the payer for the information. Shouldn't this be part of the > >"value-add" in VAN? > > > >I'm not particularly enamored of the idea of centralized databases - > >maintained by the Government or otherwise - not due to suspicion of Big > >Brother, but simply because there's no incentive to do the job right. > >Instead, it's much more likely VANs or Clearinghouses can solve these > >problems on their own. Though cooperation between profit-making > >organizations sounds counterintuitive, the ones who do just this (i.e., > >share information to better serve their respective customers) will > >probably make out in the long run. > > > >William J. Kammerer > >Novannet, LLC. > > > > > >----- Original Message ----- > >From: "Christopher J. Feahr, OD" < [EMAIL PROTECTED] > > >To: < [EMAIL PROTECTED] >; < [EMAIL PROTECTED] > > >Sent: Saturday, 19 January, 2002 06:19 PM > >Subject: RE: Payor identification codes for 837I > > > > > >Regarding the unique routing ID for the payor (NAIC code?)... whatever > >it > >is, MUST be maintained in a central directory. At least, that's my vote > >as > >a small provider. People walk through my door unpredictably with all > >sorts > >of insurance plans and if it was EASY/PAINLESS to determine where to > >send a > >standard elig. query and/or a std. claim, then I'd be less inclined to > >require the patient to pay cash and duke it out on his own with his > >insurance company. A central payor address/routing directory seems like > > > >a > >vital component. > > > >-Chris > >Christopher J. Feahr, OD > http://visiondatastandard.org > [EMAIL PROTECTED] >Cell/Pager: 707-529-2268 Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268