A sad note... Back in 1994 I asked all my providers at Synaptek (a clearinghouse) to give us power of attorney so we could enroll them with all the payers in the country that required provider enrollment. Within three months of Synaptek starting to use the power of attorney enrollments, HCFA responded with a Program Memorandum (PM) to all the Medicare Carriers instructing them to require signature by the providers themselves and NOT accept PoA enrollments. Presumably this was to prevent certain clearinghouses (we were the only ones doing this at the time) from enrolling providers without their knowledge. The fact is, the providers gave us a PoA limited to only being able to enroll them with the EDI systems of Medicare and other payers. The PoA itself was very explicit about what we were going to do. And we sent a copy of the PoA with each paper enrollment we sent to the payers on behalf of the providers.
If you search through the HCFA archives in 1994-1995 you will find this PM. I still don't quite understand why. Been there. Done that. Gave up. Kepa William J. Kammerer wrote: > 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
