Kepa, I agree. It's a huge complex "mess." That's why I continue to hammer on the need to establish a clear focus and goal for this work effort so that forward progress can be made. As you can see from all of the recent postings, all kinds of issues and challenges for the addressing and routing of X12 interchanges are being expressed.
Additionally, some are also bringing to the picture issues of security and authentication. As you know, there are all kinds of levels of security, with the first level being at the link or connection level, i.e., will I even allow this party to logon to my system? My personal vote would be to identify security and authentication as out of scope for this work group and white paper work product. Unless, of course, the real need and issue is not one of merely addressing an EDI interchange at the ISA level, but rather to address the needs for security, authentication, determining the full path an interchange takes from originator to receiver, and also addressing at the ISA level. These are issues of scope in my opinion. All of these issues are critical ones for the industry to wrestle with, come to consensus about, determine what the (perhaps new) requirements in a full X12 EDI world should be, and then to develop the guidance and support for appropriate solutions. But, this can only be achieved if a broad representation of today's problems and needs are out on the table for a full examination. I believe these past few days' worth of discussion have served to accomplish most of that. It's time for all of this to be sorted out, documented, categorized, and then a scope for the continued effort of this group to be determined. Obviously, some topics and issues will be out of scope - and perhaps those issues should then be assigned to either another existing work group or a new work group established to address them. Rachel -----Original Message----- From: Kepa Zubeldia [mailto:[EMAIL PROTECTED]] Sent: Thursday, January 24, 2002 8:55 PM To: [EMAIL PROTECTED] Cc: 'WEDi/SNIP ID & Routing' Subject: Re: Payor identification codes for 837I Rachel, Even though providers may participate in only as handful of health networks, they routinely see patients that are covered by hundreds of payers. THe exception could be some providers in very small rural communities, where there is one prevailing employer. Other than those, most providers will have in their systems a "payer database" of several hundreds of payers, with varying degree of activity. Anywhere from several claims per day to one claim per year. Then, the typical academic medical center has payer directories with several thousand entries in them. And, mergers, acquisitions, name changes, and coverage under new "service" names make things more difficult. It is also common for payers and especially TPAs to operate under a multitude of names, based on the product or the sponsor of the health plan (employer) so it is hard to nail down. An average TPA will have around 50-100 health plans under its administration, most likely under different names. All under the same roof. And the name is not always a good indicator. I still remember when BCBS of OK bought an Aetna plan in Oklahoma and kept the Aetna name for some time even though it was actually part of BCBS of OK. Then you get the repricing organizations such as the PPOs in the mix. The claim transactions may look like they are for Plan X, but cannot be sent directly to Plan X. They have to be sent to the repricer first, and the repricer will, after repricing the claims, send them directly to Plan X. But the payments or eligibility transactions could be between the provider and Plan X directly. What a mess... Kepa Rachel Foerster wrote: > > William, > > I don't think it's unreasonable to believe that many large instituional > providers submit claims to dozens, if not more, payers. I suspect that only > smaller providers that may be in more rural rather than large urban centers, > might deal with only a few payers. > > Thus far the discussion here seems to be between William and me. I'd much > prefer to hear from the actual players in these various scenarios: > providers, payers and clearinghouse. > > Rachel > > -----Original Message----- > From: William J. Kammerer [mailto:[EMAIL PROTECTED]] > Sent: Saturday, January 19, 2002 12:51 PM > To: WEDi/SNIP ID & Routing > Subject: TCS: Payor identification codes for 837I > > An interesting question re: Identifiers posted to hipaalive yesterday > causes me to come up with some of my own: > > This request reminds me of the periodic queries for directories of SCAC > codes that arise on the general purpose EDI-L mailing list: I always > wonder why people just don't ask their (relatively few) carriers for the > respective codes. Likewise, wouldn't a provider (even an institutional > one) be dealing as a participating provider with relatively few payers, > and hence only need those payers' NAIC codes? - i.e., would there really > be a need for a NAIC directory? Does COB complicate the matter? - i.e., > the secondary payer may be known only by name, assuming it's provided by > the patient. Is the NAIC commonly used as the receiver (or sender) > field of the ISA? > > Rachel: corral me in if I'm making any unwarranted assumptions! > > William J. Kammerer > Novannet, LLC. > > ----- Original Message ----- > From: "Jeffrey Young" <[EMAIL PROTECTED]> > Sent: Friday, 18 January, 2002 11:12 AM > Subject: RE: TCS: Payor identification codes for 837I > > The National Association of Insurance Commissioners issues an identifier > to nationally significant carriers. Their database enumerates over > 6,000 indemnity and managed care life, accident and health care payers. > > -----Original Message----- > From: Marcus E. McCrory [mailto:[EMAIL PROTECTED]] > Sent: Friday, January 18, 2002 6:48 AM > To: HIPAAlive Discussion List > Subject: [hipaalive] TCS: Payor identification codes for 837I > > *** HIPAAlive! From Phoenix Health Systems/HIPAAdvisory.com *** > Regarding 2010BC-NM109 (page 127) & 2330B-NM109 (page 410) of the 837 > institutional guide, what currently serves as a central repository for > all of the payor identification codes for different plans/payors > throughout the country in the absence of a national identifier? Am I > missing a previously published list or well known resource? > > Thank you
