Dave,
Testing is a different issue.
We have not come to a final testing position, but the one that seems to be
the most probable is quite interesting.
While we will probably support a testing capability, we may not require it.
With true 'standards' under HIPAA, we can alow productin submission without
initial testing. Our system will reject what is not HIPAA compliant. The
compliant transactions will be edited for our allowable business rules and
then accepted or rejected for processing.
The opinion here is that we needed to do extensive testing when providers
were programming to our specs/IGs. With the HIPAA IGs, we can back off
that requirement. The net is that providers may find that there is
actually less testing to do under HIPAA.
Bob
Dave Minch
<dave.minch@jm To: "'[EMAIL PROTECTED]'"
<[EMAIL PROTECTED]>
mdhs.com> cc: Ross Hallberg
<[EMAIL PROTECTED]>, Joe Fuchs
<[EMAIL PROTECTED]>, Michael Smith
<[EMAIL PROTECTED]>
01/25/2002 Subject: RE: Payer identification codes
for 837I
06:30 PM
I can vouch for Kepa's comment regarding many payers. We are a relatively
small Health System, but we have over 2000 payers in the insurance table of
our largest provider. Even if I assume that each company has at least 1
alias, that still leaves over 1000 profiles. That means if I want to send
directly to each payer, I need to negotiate 1000 TPAs, perform 1000 tests,
set up 1000 trading profiles, and implement however many unique transports
to deliver the claim payloads to the "first hop" recipients. And I'm just
1
provider (well, actually 15) -- think of how many of us are going to be
knocking at the payer's doors. Are you guys ready???
Then I shall simply pray a whole lot that if any one of the links in this
frighteningly fragile chain of mail carriers decides to change transports,
methods, passwords, encrypting, etc. that they give us good advance
notification, and that the information they communicate is accurate, and
that they don't decide to change things at the last minute..... Mess?? you
got that right!
Lets see....
If I can average 3TPAs per day, and get them all set up for testing it
should only take me 15 months to get all 1000 ready by 4/16/03. I guess I
can just make it if I start tomorrow... Does any of this sound as absurd
to
anyone else as it does to me?????
Dave Minch
T&CS Project Manager
John Muir / Mt. Diablo Health System
Walnut Creek, CA
(925) 941-2240
