See "EDI Meets the Internet: Frequently Asked Questions about Electronic Data Interchange (EDI) on the Internet," RFC 1865 at http://www.ietf.org/rfc/rfc1865.txt, especially sections 5.8. Can the ISA 06 or 08 identify any entity other than the 'end' Trading Partners (i.e. a routing entity)?, and 5.10. Are there other options for routing EDI X12 messages?
...although the ISA06 and ISA08 elements are supposed to be used to identify the sender and receiver of the interchange, the receiver of the interchange could be a clearinghouse (as well as a VAN) that processes the interchange and then forwards the data to the ultimate recipient. In this case, you could put the receiver ID of the clearinghouse into the ISA08. The clearinghouse would probably have to determine the ultimate recipient of the message by looking inside the transaction set (or perhaps by using the GS03). Though this IETF RFC is obviously not a HIPAA document, it proves as of 1996 that this was not a weird practice. The TA1 and 997 go back to the sender in the ISA, whether a CH, billing service or the "real" provider. What's the problem with calling the CH who builds the ISA the "sender" or "submitter" in order to differentiate him from the "providers" he's aggregating? If the provider (or his agent) puts the provider's ID in ISA06, then the provider is also the sender (or submitter). Analogously, the "receiver" could be a CH or payer. A payer is always a payer, and even sometimes the "receiver" in the ISA. I appreciate that we eventually have to get unambiguous definitions put down, but none of the stuff Bob Poiesz is describing violates some sacrosanct rule about ISAs or 837s. William J. Kammerer Novannet, LLC. +1 (614) 487-0320 +1 (614) 638-4384 (c) +1 (928) 396-6310 (FAX) ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDi SNIP 4 (E-mail 3)" <[EMAIL PROTECTED]> Sent: Friday, 01 February, 2002 01:02 PM Subject: Sender/Receiver Definitions for HIPAA As a follow up to the intermittent, but continuing, discussion of who is the "real" sender and receiver for HIPAA interchanges I did a search on the current HIPAA IG's to see what I could find. Interestingly, no where do the HIPAA guides ever indicate that the sender is or could be a clearinghouse. I think we need to clearly get this out on the table and reach consensus on this issue as well before the water gets so muddied it can't be cleared. Below are some excerpts from the various guides that illuminate this topic. Rachel Rachel Foerster Rachel Foerster & Associates, Ltd. Phone: 847-872-8070
