Thank you very much, Rachel. As I suspected, there is quite a lot to this
"TPA issue" and your email looks like a pretty decent draft-outline for a
paper. Perhaps someone could create a "TPA-Wizard" application that
conducts an interview .... resulting in a nice, searchable
rules-of-engagement book to post on the company website or print up as a
contract. Or WEDI-SNIP might consider publishing some "standard" or
prototype rule-books that people could freely copy/modify and present to
their trading partners as their own. There do seem to be some unmet needs
here.
Thanks again,
-Chris
At 01:09 PM 8/13/01 -0500, you wrote:
>Chris,
>
>Your elaboration is informative. I acknowledge that "contracted" providers
>already are under some contract (agreement) and that this contract/agreement
>could be modified to incorporate any new HIPAA-related terms and conditions.
>
>My concern is that there could be a naive perception that EDI trading
>partner agreements should also now be entered into. That's the impression I
>came away with after reading the IG's. It's this scenario that both William
>and I have a concern about, since it's not reasonable or feasible for these
>types of trading partner agreements to be consummated easily and quickly.
>
>In my consulting business I caution my clients to stay away from "EDI
>trading partner agreements" because they typically become show stoppers and
>deal breakers. Rather, I advise that a more comprehensive implementation
>manual be developed (most typically by the larger of the trading partners)
>which not only specifies the technical details of the transaction sets to be
>exchanged (this could equate to the HIPAA IG's), but also serves to align
>the business semantic of the data to be conveyed by the EDI transaction
>(again, the HIPAA IG's address this, but there still seems to be room for
>interpretation), establishes the business rules for the interface -
>including not only the business rules to be applied to the data, but the
>business rules that control the process and the business relationship, and
>also provides all of the other information needed to successfully establish
>and electronic business message exchange, such as communications
>methods/modes, use of VANs, clearinghouses, Internet, message security
>requirements, hours of operation, anticipation processing turnaround cycles,
>key contacts, etc. In other words, just identifying the data and the format
>is the first step, and all of this other "rules of engagement" must also be
>provided if there is to be any hope of a speedy, accurate, timely, and
>working electronic business message exchange.
>
>Right now it appears to me that much of this information is scattered all
>over the universe and trying to pull it together into one comprehensive
>guide is daunting for even the largest and most sophisticated of
>enterprises, let alone for the smaller ones. Successfully establishing an
>integrated (or even a read/rip/rekey) EDI interface is not a walk in the
>park - witness the fact that no other industry anywhere in the world has
>been able to get beyond a 20% adoption rate (at best), and now we're
>expecting this highly fragmented health care industry composed of mostly
>small to medium businesses to achieve in two years what other major
>industries with somewhat unlimited resources could not and have not achieved
>in over two decades of trying!
>
>I give our industry gold stars for attempting this, but the proof will be in
>the pudding, which we'll all have to be eating in 2-3 years (or less now for
>EDI)!!
>
>Perhaps a white paper might be helpful on this topic.....
>
>Rachel
>
>Rachel Foerster
>Principal
>Rachel Foerster & Associates, Ltd.
>Strategies for Electronic Commerce
>39432 North Avenue
>Beach Park, IL 60099
>Phone: 847-872-8070
>Fax: 847-872-6860
>http://www.rfa-edi.com <http://www.rfa-edi.com>
>
>
>
>
>
>-----Original Message-----
>From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]]
>Sent: Monday, August 13, 2001 11:24 AM
>To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
>Subject: RE: 271 Transaction Disclaimer
>
>
>Rachel,
>I think I understand the valid points that you and William are making about
>the potential burden of trading partner agreements. I find it hard to
>fault this as a recommendation. But if the law and the implementation
>guides are clear enough, I doubt that very many people will require TPAs
>solely for the process of moving information around. I am a provider and I
>do have to sign some kind of "provider agreement" with every insurance
>company I want to be bound to as a "contract provider". In the cases where
>I'm billing a payor without such a contract, I am essentially acting as the
>patient's agent, in which case the patient's contract with the payor would
>apply. I'm just proposing that payors insert any words or disclaimers they
>feel are necessary (about EDI, HIPAA, etc.) into the existing
>contracts. If transactions are currently taking place without a specific
>contract between the "communication partners", then I don't see why that
>could not continue that way in the post-HIPAA world.
>
>But maybe there is more to it. If you feel that payors are about to waste
>a lot of resources trying to implement this "recommendation" for an
>agreement with every potential partner, then maybe a white paper should be
>developed, making the case for a TPA in certain situations... relying on
>the clarity of the IG and the law in all others.
>
>Regards,
>-Chris
>At 10:19 AM 8/13/01 -0500, Rachel Foerster wrote:
> >Chris,
> >
> >While your response was informative relative to the transmission of a
> >disclaimer statement within the 271, it did not address what I believe is
> >William's core question. That is, the apparent recommendation in all of the
> >IG's themselves that trading partner agreements be entered into to address
> >certain business rules, and the fact that it most likely is not feasible
>nor
> >reasonable to expect providers and payers to enter into such trading
>partner
> >agreements on any mass scale.
> >
> >As a matter of fact, the federal government, when it first transitioned to
> >EDI from their proprietary ways in the early-middle 1990's initially
> >required a trading partner agreement be entered into between the
>contracting
> >office and the potential supplier. This requirement all but killed the
> >federal government's (I believe it was actually the DOD) EDI effort and
>they
> >quickly (within 6 months) killed the use of trading partner agreements.
> >
> >Other industries have long since recognized that trading partner agreements
> >are the deal breakers when two enterprises trying to establish EDI
> >interfaces between their respective systems and have long since discarded
> >them in favor of implementation manuals that don't have the aura of legal
> >requirements that gets the lawyers involved.
> >
> >Rachel Foerster
> >Principal
> >Rachel Foerster & Associates, Ltd.
> >Strategies for Electronic Commerce
> >39432 North Avenue
> >Beach Park, IL 60099
> >Phone: 847-872-8070
> >Fax: 847-872-6860
> >http://www.rfa-edi.com <http://www.rfa-edi.com>
> >
> >
> >
> >-----Original Message-----
> >From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]]
> >Sent: Sunday, August 12, 2001 5:36 PM
> >To: [EMAIL PROTECTED]
> >Subject: Re: 271 Transaction Disclaimer
> >
> >
> >William,
> >I think the original question was regarding the best place to insert
> >disclaimer text in the 271, stating that the response was not a guarantee
> >of payment. Someone did suggest a suitable field for it, but it seems
> >unlikely that a provider (human) would ever see it there... unless they had
> >specifically programmed the receiving system to capture that text and
> >display or print it.
> >
> >Disclaimers should be reserved for the truly unsophisticated user...
> >someone who is actually *likely* to make the error out of ignorance or
> >misunderstanding. A patient might make this mistake, and since the patient
> >is not a covered entity, you would have great flexibility with the
> >disclaimer text placement. (I recommend not bugging the doctors with this
> >stuff.)
> >
> >Regards,
> >-Chris
> >
> >At 07:01 PM 8/10/01 -0400, you wrote:
> > >Sandy Young, Joey Lawhorn and Christopher J. Feahr all tell Dana Grant
> > >that "section 1.3.10 [in the HIPAA IG ASC X12N 270/271 004010X092]
> > >encourages disclaimers to be outlined in the trading partner agreement."
> > >
> > >A na�ve question: how does every payer in the country maintain a trading
> > >partner agreement with potentially every provider they'll ever deal
> > >with?
> > >
> > >TPAs....oops, "companion documents" ... "should not be required for
> > >acceptance of a transaction as valid." The payer "may not reject the
> > >transaction merely because they cannot process an explicit request."
> > >
> > >William J. Kammerer
> > >Rachel Foerster & Associates, Ltd.
> > >
> > >
> > >
> > >
> > >**********************************************************************
> > >To be removed from this list, send a message to:
> >[EMAIL PROTECTED]
> > >Please note that it may take up to 72 hours to process your request.
> >
> >Christopher J. Feahr, OD Vision Data Standards Council
> >Executive Director http://visiondatastandard.org
> >Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
> >
> >
> >
> >**********************************************************************
> >To be removed from this list, send a message to:
> >[EMAIL PROTECTED]
> >Please note that it may take up to 72 hours to process your request.
> >
> >
> >
> >**********************************************************************
> >To be removed from this list, send a message to:
>[EMAIL PROTECTED]
> >Please note that it may take up to 72 hours to process your request.
>
>Christopher J. Feahr, OD Vision Data Standards Council
>Executive Director http://visiondatastandard.org
>Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
>
>
>
>**********************************************************************
>To be removed from this list, send a message to:
>[EMAIL PROTECTED]
>Please note that it may take up to 72 hours to process your request.
>
>
>
>**********************************************************************
>To be removed from this list, send a message to: [EMAIL PROTECTED]
>Please note that it may take up to 72 hours to process your request.
Christopher J. Feahr, OD Vision Data Standards Council
Executive Director http://visiondatastandard.org
Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
**********************************************************************
To be removed from this list, send a message to: [EMAIL PROTECTED]
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