Marcallee Jackson has graciously offered to start the ball rolling on Trading Partner Agreements - or, more correctly, how to avoid the paper versions of them. As you'll recall from previous discussions, sometimes the manual EDI enrollment processes and concomitant paperwork are so complicated and take so long that providers are sometimes unwilling to undertake the hassle, especially if their volume of claims to a particular payer is relatively low. That means more stuff is dropped to paper when one or more of the parties can handle electronic transactions.
Though the legal issues behind TPAs are - strictly speaking - not really in our charter, the consensus seems to be that if it takes 2-8 weeks to get the paperwork done for electronic trading, it would surely throw some cold water on the ideal of providing automatic and instantaneous means of "discovering" EDI addresses! To see just what hassles a paper TPA entails for Clearinghouses, see Marcallee's posting from 20 February, 2002: "It takes providers as long to complete their part of the enrollment paper work for these payers as it does for most to complete testing, implementation, training and full production for payers who don't require it. That's if the enrollment process goes well." Marcallee has arranged to have some legal folks she knows help us out in determining TPA requirements under HIPAA (if any). Right now, we have Marcellee, Dave Minch and Rachel Foerster from our group working on this effort. We do already have representation from the Clearinghouse, Big Provider and CMS perspectives. But there's still room for someone from the Big Payer side of the house to help out - especially a Big Payer who insists on paper TPAs and enrollments. If you're a Big Payer, would you volunteer by writing or calling me privately? Marcallee believes the scope of this effort would entail: 1. Electronic TPAs - machine readable documents that outline information proprietary to the payer; e.g., information on routing and information related to proprietary requirements for HIPAA transactions (stuff that would normally be part of a companion guide). 2. EDI Enrollment - This is a process today that requires the provider to sign an EDI agreement before exchanging transactions. This is a time consuming process and a barrier to fuller utilization of EDI. It's of particular concern to providers and clearinghouses since many health plans seem to be planning on this same requirement which could dramatically impact cost and timelines to implementation. Among other payers, every Medicare intermediary requires this process today. The primary question would be - is this legal post HIPAA? If yes, then the second issue and third topic here would be: 3. An EDI Power of Attorney - This would allow a provider to assign their clearinghouse power to enroll them with other trading partners (clearinghouses, payers, etc) for the purpose of exchanging healthcare transactions. Please also remember: we have a WEDi/SNIP ID & Routing teleconference scheduled for Friday March 8, from 1:30 - 2:30 EST, 703-736-7290, pin #1315331. William J. Kammerer Novannet, LLC. +1 (614) 487-0320
