RE: clearinghouse/provider relationship

[Catherine Lohmeier]

I just saw a posting on the Business Issues list that said they have a draft response to a question very much like the one we have been discussing.     I have asked if the draft response is for public viewing yet.  If so I’ll post the link to this group too.   I have read the other postings on this thread this morning and I must say this is the best discussion of this subject that I have heard/read since I started working with these rules three years ago.  My compliments to all involved.   As we all can see, this is a complicated matter and HIPAA itself gives no direction other than stipulate the “don’ts” that have already been pointed out in this discussion.   I think, along with Kate, that William’s example is a good one and it highlights another possible variation in the market place that might give us guidance.  If a payer has done their homework and provided a variety of connection options for providers to use at no additional cost, and one doctor says those options won’t work for them…what next?  Legitimately, as in the ATM example, the one who chooses to go outside the defined network should be responsible for any charges incurred.   I also remember encountering the clearinghouse volume issues that Rachel wrote about.  Also, some payers did not do EDI or didn’t do it with the clearinghouse I worked with.  Some providers were locked into using a specific clearinghouse due to the relationship the PMS vendor had with the clearinghouse.   My understanding is that the setup costs with new connections, between any computers in any industry, come mainly from doing the testing.  An industry standard format for the transaction should reduce the testing time and therefore the cost.  It may not be reduced day one, but certainly in the near future.   That is the purpose of the standard format.   I am beginning to think that we need a clearinghouse representative to chime in here and let us know how they are viewing this situation and what plans they have to help facilitate the inevitable connections we have been discussing.  It seems the business models they have been using in the past will not work once HIPAA is in effect.  If they don’t adjust something then it will leave payers and providers in this potentially adversarial position and that will only make things worse in this industry.     Catherine Lohmeier Implementations Project Lead OD Professional™ Team   --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org