Robert, Agree with Kepa we have a mess.. More so than the point recently discussed regarding path of just the 837 - a routing methodology describing intended/mandatory delivery points for most of the transactions needs to be identified. = my 2 cents worth = 1) I think with the attachments that are going to be requested electronically, eventually protection of PHI dictates that we know the path the transaction takes, and who has access to the information. Routing path tracking and descriptions are key and we should address it as job 1. 2) Furthermore, delivery of the 835 as well as the 278 should be able to be routed by preference to accommodate apps that reconcile 837's with 835 and other reroutings that we should probably identify - including purchasing of subscriber groups. This is not accommodated by any process electronically that I know of and we may desire to look at audit processes used by the banking industry or maybe used in the SS7 (cell phone) bandwidth. This is not necessarily in #1 above and otherwise would be a manual process. We need to identify means to do this and be able to audit changes to routings.
I am very encouraged by the intellectual capacity represented by this group... and the ability to address these issues successfully. Joe Joseph Schein Sr. Consultant 757-270-3069 Co Chair - MAHI Mid Atlantic Health Initiative, Inc. See our website at www.mahicentral.org [EMAIL PROTECTED] MAHI - Saving Time and Money on HIPAA Compliance -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Friday, January 25, 2002 8:25 AM To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Subject: RE: Time-out for terminology question(s) There are additional issues with the 835. HIPAA does not link the 835 with the 837. A provider can ask for the 835 without sending electronic claims. Providers sometimes send claims through multiple routes. They can even want to the 835 to return through a different route (like a bank). The payer must be told when a provider wants an 835 and which route to use. Sending information down the wrong route can be a privacy problem. To keep it short - there is NO substitute for provider to payer communications for the 835. Bob Dave Minch <dave.minch@jm To: [EMAIL PROTECTED] mdhs.com> cc: [EMAIL PROTECTED] Subject: RE: Time-out for terminology question(s) 01/24/2002 06:43 PM William, I would guess that, following the pattern that appears to be present for claim submission which i just finished commenting on, routing of the 835 or 277 would not depend so much on the ISA sender as it would on the 1000A submitter. The 1000B receiver would have to have my "first-hop" address to put into the ISA to respond to me. If that is true, does it imply that i actually need to have a TPA with every payer i send information to? (yuck..!!) or if I use a CH, is it their job to update the next hop's routing tables (same question that you just asked), and so forth until the payer's routing tables are eventually updated with my submitter id & route information? How does it work today when the paths are: Claim: provider ---> prov's CH ---> payer's CH ---> payer Remittance: payer ---> prov's CH ---> provider (note the omission of the payer's CH) Dave Minch T&CS Project Manager John Muir / Mt. Diablo Health System Walnut Creek, CA (925) 941-2240
