We have to be on the constant lookout for potential recruits. Hopefully, we'll produce our recommendations long before the last of us die off. Below are two postings evangelizing on the HIPAAlive mailing list; other news on the evangelizing front:
(1) Bruce Horn gave a presentation on the Addressing and Routing initiative from a business perspective at the BCBSA meeting in Chicago the week before last. I understand there was standing room only, and Bruce was besieged for autographs afterwards. (2) Peter Barry presented at a NIST Workshop on Healthcare Interoperability at Gaithersburg at pretty much the same time - He discussed DDE, with a little smattering about ID & Routing. (3) Dave Minch is adapting a short overview of the project for inclusion in the HIMSS HIPAA SIG Newsletter. (4) Peter Barry and I will present at SNIP Summit in Chicago on 09-10. (5) I am tentatively scheduled to present "Advanced HIPAA Issues: Implementing a Healthcare Collaboration-Protocol (CPP) Registry" on 11-01 at the Fifth National HIPAA Summit in Baltimore. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "William J. Kammerer" <[EMAIL PROTECTED]> To: "HIPAAlive Discussion List" <[EMAIL PROTECTED]> Sent: Sunday, 11 August, 2002 05:44 PM Subject: [hipaalive] Re: TCS: Required to use clearinghouse *** HIPAAlive! From Phoenix Health Systems/HIPAAdvisory.com *** �162.925 (a)(5) says that payers, in effect, must provide an open or free portal for providers (or their agents, e.g., clearinghouses or billing services) to submit or receive standard transactions. Once the payer has made a "free" conduit available, her obligation is satisfied. Of course, we could argue a bit over what constitutes a reasonable "conduit" - it probably must be electronic (as opposed to a mail box for diskettes containing standard transactions), using a reasonably standard communication protocol (e.g., SMTP e-mail, IETF EDIINT, FTP, etc.). Under HIPAA, the payer is not forced to pay the fees of a clearinghouse which forwards a provider's standard transactions. The provider freely chose to use his own clearinghouse (or billing service). The payer is compelled by law to accept them (directly, or at her own clearinghouse) at no charge to the provider or his agent. It's up to the provider's freely-chosen CH to work out a business arrangement with the provider, its customer, on how it will be compensated for forwarding standard transactions to the payer's "free" portal. It's none of the payer's concern how this is done: she's ready and willing, as the law mandates, to take in standard transactions when the provider and his CH have resolved matters between themselves. As is the case today, she will still be perfectly within her rights under HIPAA to refuse to pay a toll to the provider's clearinghouse. If the provider and his clearinghouse can't come to some mutually acceptable agreement, the provider is always free to build the standard transactions himself and send them to the payer's "free" portal directly. If the payer does decide, for her own reasons, to have some business arrangement (i.e., become a subscriber or customer) with the provider's clearinghouse in order to expedite clearance of standard transactions, then she may well choose (but is not compelled) to "subsidize" providers using the same clearinghouse to exchange standard transactions with her. �162.925 (a)(5) provides much of the impetus behind our work within the WEDi/SNIP ID & Routing Special Interest Group: one of the questions we hope to answer is "How do I find this 'free' portal?" If you wish to participate in developing recommendations for technical solutions which expedite the routing and exchange of standard transactions between various Healthcare stakeholders, please join our listserve by checking off "Routing - [EMAIL PROTECTED]" at http://snip.wedi.org/listserv/. William J. Kammerer Co-Chair, WEDI/SNIP Business Issues ID & Routing SIG Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 I don't believe you will "have" to pay. But before you get to the point of receiving transactions from a clearinghouse, won't you have to have a trading partner agreement? Maybe as you work through that you will see the value of paying for the clearinghouse service or you won't. I would imagine that there will be some cost to a payer to set up the exchange with any sender. Would it be less costly to work with a clearinghouse that represents many providers, or would it be less costly to work with each provider individually. I know of one clearinghouse that presently provides services to many payers, but the cost to set up the compliant edi system was too costly on the provider side and the providers are out shopping for more cost effective solutions. It may be a good idea to have a contingency plan, just incase the clearinghouse of your choice does not come through. Barbara McGowin, CPCExecutive RecruiterHIT Recruiting(843) [EMAIL PROTECTED] Healthcare Organizations with People,Products and Services to Achieve HIPAA Compliance. Deborah Campbell wrote: *** HIPAAlive! From Phoenix Health Systems/HIPAAdvisory.com *** I understand that 162.925, requires us as an insurer to accept a standard transaction if it is submitted. Here's my question. Many of our providers use clearinghouses to do their billing. The clearinghouse then transmits the claims electronically. The clearinghouse charges both us and the doctor (they are not our clearinghouse). Because of this, we have not allowed these clearinghouses to submit electronically. Under HIPAA will we be forced to pay their fees and accept the transactions electronically? Or will we only be required to accept the electronic transactions if we won't be charged for it? Deborah Deborah Campbell Compliance Coordinator Dominion Dental Services, Inc. 115 South Union Street, Suite 300 Alexandria, Virginia 22314 Phn: (703) 518-5000 ext. 3035 Fax: (703) 518-8849 Toll Free: 888-518-5338 Email: [EMAIL PROTECTED] ----- Original Message ----- From: "William J. Kammerer" <[EMAIL PROTECTED]> To: "HIPAAlive Discussion List" <[EMAIL PROTECTED]> Sent: Sunday, 11 August, 2002 07:05 PM Subject: [hipaalive] Re: TRANSACTIONS: Payor Code *** HIPAAlive! From Phoenix Health Systems/HIPAAdvisory.com *** Paula Brooks of LifeCare Management Svcs asked on Friday if there was "a national list of payor codes that exists somewhere, and if so where [is it] and can it be purchased?" Well, someday there will be a National Health Plan Identifier (formerly, the National Payer Identifier) - a single consistent identifier used for identifying any plan throughout the nation. Theoretically, the health plan ID would appear on a patient ID card, and you'd be able to use that number to obtain information about the party (e.g., insurer or TPA) who administers the plan, expediting the exchange of standard electronic transactions. The National Plan ID doesn't exist yet, though, unfortunately. In the meantime, you're stuck using a plethora of ID domains to identify payers (e.g., the NAIC company code), along with proprietary means to cross reference plans and payers. Perhaps your Clearinghouse can assist in helping you identify payers and plans. In addition, there is a web-based service, called PayorID, which seems to be a directory of over 25,000 Payors and 35,000 employer health plans; see http://www.payorid.com/. I've been told this has been around for about two years, but I don't know if anyone uses it. I wonder how the information is compiled. Generally, centrally managed for-profit directories (� la EDI Yellow Pages) don't seem to have successful track records. Identifiers, and how they're used to locate entities which exchange standard transactions, are an integral part of our work in the WEDi/SNIP ID & Routing Special Interest Group. If you wish to participate in developing recommendations for technical solutions which expedite the routing and exchange of standard transactions between various Healthcare stakeholders, please join our listserve by checking off "Routing - [EMAIL PROTECTED]" at http://snip.wedi.org/listserv/. William J. Kammerer Co-Chair, WEDI/SNIP Business Issues ID & Routing SIG Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
