Chris Feahr wrote: One way for the Little Provider to simplify his addressing/routing life would be to send only one kind of "thing" in each interchange, allowing his/her transaction-addressing to essentially be accomplished in the ISA... and allowing this group to focus on the ISA receiver without ignoring the LP's need to discover the ultimate target address for the transaction. Is this a reasonable "best practice" recommendation for a "small provider"?
Chris: If different EDI addresses are available for a payer depending on the type of transaction (e.g., claims go to a repricer entity, eligibility inquiries go to a special fast-batch queue, etc.), then only one kind of "thing" can be placed in an interchange, since each has to be routed separately. That doesn't mean I'm softening on the issue of routing to different EDI addresses for the same payer depending on the functional group (but I might have to!). This might not be a "best practice" recommendation for a "small provider" - it may be the way everyone does it; i.e., one functional group - one kind of "thing" - per interchange. Which leads me to whine: why do providers have to send their claims to repricers? Why don't they send them to the Third-Party Administrator or the Payer directly, who then in turn can send them to the repricer? Actually, what's re-pricing? - is that where they set the maximum customary allowable fees based on a geographical area, or something like that? Why isn't that something TPAs or payers do themselves? William J. Kammerer Novannet, LLC. +1 (614) 487-0320
