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]
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>
>
>
>**********************************************************************
>To be removed from this list, send a message to:
[EMAIL PROTECTED]
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Christopher J. Feahr, OD Vision Data Standards Council
Executive Director http://visiondatastandard.org
Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
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