So we all agree, incentives from the payor to the provider should be allowed.
Especially if you think about it in the following light. Industry experts estimate it costs a payor $5-$15 to take a paper bill and turn it into a check. If a provider uses edi correctly, these costs are brought down to maybe $1 per successful EDI submission. In fact, I beleive there are payor sponsored programs at least in California that allow the payor to pick up the $0.25 EDI Clearinghouse Costs on behalf of the providers. Doesn't this count as an incentive program? -----Original Message----- From: Mimi Hart [mailto:[EMAIL PROTECTED]] Sent: Monday, June 24, 2002 8:46 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: Online Authorization / Referrals I am not Martin, but I believe there are times we agree..and I will provide a "provider" side view of this issue... In my personal opinion, if as a Provider, I upgrade my technology appopriately, after entering patient demographic/clinical data once, I should be able to push "send"..and a real time/batch authorization/referral request will be sent to ANY payer I have taken the time to set up EDI technical specs with..and their answer should come back to me real time/batch - directly into my app, without retyping it... If I use a payers proprietary front end....be it web or otherwise..I must "type in or do a search of somekind"...taking me out of my app..then, once the response is received...I must enter it into my app...you are talking at least three entries of data vs one the "HIPAA compliant" way... So why would I use their front end? Only if they provide "incentive/disincentive"...only giving me a yes/no answer....not making "enrollment" in their EDI system easy..or providing more information on their proprietary system then they provide via EDI...all of which I think are blurring the line..but which some may well do....... Hope this helps.. Mimi Hart Research Analyst, HIPAA Iowa Health System 319-369-7767 (phone) 319-369-8365 (fax) 319-490-0637 (pager) [EMAIL PROTECTED] >>> "Todd Leeders" <[EMAIL PROTECTED]> 06/20/02 02:15PM >>> Martin, I'm very new to the industry, in that I am returning to it after 8 years of being away, so please excuse the simpleton inquiries. I do however possess 15+ years of IT Experience, so feel free to be technical in your response. Simpleton Inquiry: Regarding the "You must not give incentives of any kind to make partners use Inet Solutions". If one of the end in mind goals of Administration Simplification via Inet & EDI solutions is to lower the overall cost of health insurance and the provision of health services. Why would "government" prohibit a payor form incenting a provider? Taking a common sense approach there are only two ways to get a provider to use such a system and lower overall industry costs: 1. Payor or Government (Incentives) 2. Government Non-Compliance (Punishment) If you have insight into the reasoning, would you please pass it along? Sincerely, Todd Leeders -----Original Message----- From: Martin Scholl [mailto:[EMAIL PROTECTED]] Sent: Thursday, June 20, 2002 10:45 AM To: Scott Barley; [EMAIL PROTECTED] Subject: Re: Online Authorization / Referrals NO, You don't have to convert to X12. but..... 1.) you have to provide and process the same data content that the standard transaction has 2.) you still have to provide a standard system, even though your internet solution may be faster, more elegant and well appreciated. 3.) You must not give incentives of any kind to make your partners use the Internet solution over the standard one. Hope this helps Martin Scholl Scholl Consulting Group, Inc. 301-924-5537 Tel 301-570-0139 Fax [EMAIL PROTECTED] www.SchollConsulting.com ----- Original Message ----- From: "Scott Barley" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, June 20, 2002 11:17 AM Subject: Online Authorization / Referrals > Question: > > A payor is providing an internet based product to their providers for the > submission of referral/authorization requests directly into the payor's > system. The provider manually enters a request for an authorization within > the web application and the info is inserted directly into the database from > the web application. Since this is an extension to the payor's system > application and is not a system to system transaction, is their any need to > convert to ANSI 278 before placing into the system? > > > Thanks in advance for any info on this! > > Scott Barley > ********************************************************************** 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. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The 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. ********************************************************************** 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. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The 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.
