DDE does not necessarily imply real-time (for example, a payer may sponsor
an on-line web screen where providers can key in healthcare claims. No one
expects the payer to adjudicate and pay the claim in real-time if a
provider uses that DDE capability).
On the other hand, X12 does not necessarily imply batch (for example, it is
possible for a payer to support a real-time X12 request/reply capability
with their trading partners to support eligibility or claim status
transactions).
I think we normally associate DDE with real-time and X12 with batch, but
there are some cases where that doesn't hold true.
Catherine Schulten
Sybase, Inc
6550 Rock Spring Drive
Suite 800
W: 301-896-1467
C: 703-338-6955
"Barton, Joe"
<BartoJP@dshs. To: "'[EMAIL PROTECTED]'"
<[EMAIL PROTECTED]>
wa.gov> cc:
Subject: RE: Computer-to-computer HTML
under the transaction
03/26/2002 regulation
07:22 PM
Please respond
to
transactions
That is my understanding also, which leads to the fact that the ASC X12
committee meetings have been working on an XML version most likely for
realtime.
Joe
-----Original Message-----
From: Reynolds, Steve [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, March 26, 2002 3:46 PM
To: '[EMAIL PROTECTED]'
Subject: RE: Computer-to-computer HTML under the transaction regulation
My understanding from CMS is that you must do EDI X-12s but not real-time.
Steven Reynolds
Chief Information Officer
Horizon Mercy
275 Phillips Boulevard
Trenton, New Jersey 08618-1426
www.horizon-mercy.com
E-mail: [EMAIL PROTECTED]
Phone: 609-538-0700 X 5112
Fax: 609-538-0858
Cell: 609-206-4681
-----Original Message-----
From: Owens, Kris [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, March 26, 2002 10:11 AM
To: '[EMAIL PROTECTED]'
Subject: RE: Computer-to-computer HTML under the transaction
regulation
Rishel,
If I am reading between the lines in your communication - you have
made the statement that if we are doing DDE we must also do REAL-TIME
x-12. Last I understood this was still up for debate - I understood
that yes, we must offer x-12 transactions, but not necessarily
"real-time" - this centered on the discussion about what an incentive
is. Has there been clarification from HHS on this? Peter Berry in
his white paper on DDE transactions poses the question to HHS, but I
was not aware of a response.
Kris Owens
Senior Project Manager - HIPAA Project
Presbyterian Healthcare Services
505/923-8108
[EMAIL PROTECTED]
HIPAA means a higher level of healthcare.
-----Original Message-----
From: Rishel,Wes [mailto:[EMAIL PROTECTED]]
Sent: Monday, March 25, 2002 10:35 PM
To: [EMAIL PROTECTED]
Subject: Computer-to-computer HTML under the transaction
regulation
A not uncommon way of sending "real-time" transactions today
computer-to-computer is to have the sending computer send HTML to
a health plan's web server, simulating what would have come from
a person using a Web browser to access the health plan's Web
server.
This is not acceptable under the transaction regulation.
However, what happens if the Web server is being run by a
clearinghouse, which is converting the input to X12 and sending
it to the payer? I think that MedUnite does a bunch of this,
among other clearinghouses. It appears that that would be legal,
right? This would not be legal under the DDE exception, which
seemingly applies only to provider-payer interactions, but it
would be legal under the general definition of a clearinghouse
which can accept data in any old format that it wants and then
convert it to the mandated format.
What about the reverse? Can a clearinghouse accept standard X12
transactions and deliver them to a health plan using HTML? I
think that the answer once again is yes, because a clearinghouse
can accept a standard format and deliver it in whatever format it
wants.
So then, what happens if the clearinghouse converts the
machine-to-machine HTML to X12 "for one microsecond" and then
converts the X12 back to HTML and forwards it to the payer's web
server. This appears to be legal, so long as the DDE web screens
in use are fully the equivalent of the X12 transactions. This
appears to be a loophole that would permit providers who have
been sending "pseudo EDI" machine-to-machine in this manner to
continue to do so.
One might ask, "why would anyone want to do it this way when it
would be more efficient and robust to use X12?" Indeed, the main
incentive to do this goes away when health plans start offering
"real time" X12 transactions, which they must if they want to
continue to offer DDE.
The only reason that I can think of is that where providers are
already sending transactions this way it would be easier in the
short term to modify the code to match a fully compliant DDE Web
Server than to buy, configure, and debug a software mapper. Very
short-sighted, but the question does come up.
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