Chris:

I'm just a populist at heart!

But I'm also a little confused!  If you (a provider) have a standard
claim transaction intended for a particular National plan ID, say
987654321, you would build a single 837 with the payer (or plan?)
indicated in the NM1 within the 2010BB loop.  You would not comingle
claims for multiple payers or plans, like a CH might (as Bob Poiesz has
illustrated).

So, who else's ID - other than the payer's - would be in the ISA
receiver field?  There does seem to be a relationship when standard
transactions go from provider to payer, unmolested, via a VAN or EDIINT
software.  I suppose if you've been told, via Kepa's "directory," that
claims for PlanID 987654321 go to WebMD, WebMD might demand that their
ID be in the ISA receiver field - but yet, they already know they're the
receiver! In that case, it's almost irrelevant what's in the ISA
receiver field - WebMD sounds like they're going to strip search the 837
anyway in order to combine your claims with those of other providers
intended for whatever TPA or Payer handles PlanID 987654321.

William J. Kammerer
Novannet, LLC.
+1 (614) 487-0320


----- Original Message -----
From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]>
To: "William J. Kammerer" <[EMAIL PROTECTED]>; "WEDi/SNIP ID &
Routing" <[EMAIL PROTECTED]>
Sent: Saturday, 09 February, 2002 07:46 PM
Subject: Re: Using a hybrid DNS


William,
Thanks for your ongoing concern for us "little people (providers)", but
the more I think about divorcing the payor/plan ID info in the
transactions from the receiverID info in the ISA, the more I like it...
because it embraces the models in use today in which there really is no
relationship between these two addresses.  If the industry is willing to
adopt the distributed address directory model that Kepa is proposing,
then the "little people" can either hound their office system vendors to
include that capability... or the smart vendors will see the business
opportunity and sell the address discovery process to the provider as a
value-add...or the small provider can just shovel all of his claims to
one clearinghouse and let the CH worry about routing them.  Since the
need to know where to send these interchanges is going to be so acute
for the provider, I can't imagine a situation in which no one was
willing to create a system that would do the address discovery for them.

-Chris



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