WWW and EDI: The need

Tim Berners-Lee (timbl@www3.cern.ch)
Wed, 15 Dec 93 11:30:29 +0100

I just had to forward this one too! - tim

Date: Tue, 14 Dec 1993 08:33:52 -0700

I just returned from the interim meeting of X12 Subcommittee J, Technical
Assessment, in Scottsdale. The health care industry is really pushing
interactive EDI, which they characterize as real-time, immediate response
rather as opposed to normal, batch EDI. The rationale:

"Providers of health care are demanding immediate access to clinical
histories as well as payer coverage and delivery rules that effect how they
might deliver or be reimbursed for services rendered. Payers desire
the ability to manage patient access to available health care services
by requiring justification for services before they are delivered.
Patients expect that their insurance coverage will afford them immediate
access to the care they require. When they enter the provider's office,
patients expect that questions of coverage and reimbursement will not
delay delivery of the care they need...."

The health care industry has submitted to Subcommitte J business
scenarios involving requestor (provider), service intermediary, and
responder all linked through a dial-up connection, leased line, or a
virtual private circuit. This industry believes immediate response EDI
will be used not only by providers of health care, but the Health Care
Finance Administration (HCFA); Medicaid; commercial payors, third-
party administrators and Blue Cross/Blue Shield; and property and
casualty companies.

The health care industry is now developing X12 guidelines for
interactive EDI through Subcommittees N and C. I believe this subject
may have a significant impact on the education community and its
current and future EDI applications.

Betsy Bainbridge
AACRAO EDI Coordinator