-----Original Message----- From: Marcallee Jackson [mailto:[EMAIL PROTECTED]] Sent: Saturday, January 26, 2002 10:52 AM To: Rachel Foerster Subject: FW: TPA's Hi Rachel- I'm still having a problem posting to the routing list. Would you please post one more for me? Thanks, Marcallee -----Original Message----- From: Marcallee Jackson [mailto:[EMAIL PROTECTED]] Sent: Saturday, January 26, 2002 8:21 AM To: [EMAIL PROTECTED] Subject: re: TPA's I'll be bringing the issues of TPA's back to the BI work group. I hope the group will choose to address this topic ASAP. Payer to provider TPA's, required even when there is no direct connectivity between the two, will cause the labor costs associated with EDI enrollment to sky rocket. I'm certain that payers who do not require this today (and the vast majority of payers do not) will incur very significant costs to develop and support the process. Clearinghouses most often facilitate this process by managing forms distribution, provider support, routing agreements to the payer, follow-up and approval notification. Today, providers using a clearinghouse must complete enrollment paper work (TPA's) for 3 or 4 payers. If this number jumps to 25 or 30 a clearinghouse could see its enrollment costs as much as tripling. Eventually, this cost will likely be passed on to the provider who will add new fees to their own internal costs of completing 25 - 30 proprietary agreements. Already one vendor who has an exclusive agreement with one clearinghouse has begun to charge $50 per physician per agreement. For one of my clients, the total charge was over $8,000. This enrollment process is also one of the greatest obstacles to a swift implementation. Most Medicare and Medicaid plans take 6 to 8 weeks to complete the process. That's after the clearinghouse spends 4 - 6 weeks getting completed paper work from the provider. How many weeks will it take when every payer asks for a TPA? I'm looking forward to working with other SNIP participants to find a better way to handle this. Marcallee Jackson Long Beach, CA 562-438-6613 -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Friday, January 25, 2002 5:25 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
