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Show HN: Eligible API for 700+ Health Insurance Companies

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Re: Show HN: Eligible API for 700+ Health Insurance Companies

#81

Post by logjam »

kategleason wrote: post #78
logjam wrote: post #73

Earlier quoted context omitted.

Just curious - how is it that you have claim data? In fact, how is it that you (if I'm not misunderstanding) are storing any actual live data whatsoever? Just to clarify...you have some data with patient identifiers already "removed"...or are you stripping it yourselves before sharing? If the latter (which I hope is not true), how would a third-party like you obtain identifiable data? Why would a third-party providin…

Hey logjam! Let me know what specialty you are and how many insurance companies you currently accept when you have a minute. To answer your question: No, we do not have access now nor plan to have access in the future to claims data. The raw X12 I am referring to is a 271 format only (eligibility) and will be generated by our own sample transformation tool. However; it will be based off data passed (with stripped pat…

So actual patient data is being stored and manipulated, and manually "stripped" so that it can be posted (in effect) to the web? Again, I don't want to misunderstand you, but you feel comfortable doing this? I wouldn't.

Please provide your backup, retention, deletion, access logging, etc., policies on that data you are manipulating.

Am I understanding that an audit two months from now (you log your access and use of this data as required by HIPAA, right?) will indicate that this data was "stripped" and shared?

I would be very very cautious about thinking that "stripping" data like this isn't very prone to error, and to not realizing that storing and sharing this kind of data without a lot of care and thought could create huge problems.

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#82

Post by logjam »

kategleason wrote: post #79
logjam wrote: post #77

Earlier quoted context omitted.

Many many. I just discussed this with our office manger - checking eligibility is not a problem for us (nor would it be for most practices in my opinion) using web services already in place....and especially not free vs a dollar per 20 queries. I'm not actually a fan of insurance companies, but please explain why I would want to pay for the hassle of dealing with Yet Another third-party and at the same time expose my…

I see. We certainly would not expose your patient's data. My reply at bottom should help clear that up for you. You forgot to mention what specialty you are?

No, actually your reply doesn't describe your security practices at all. Why are you retaining live data at all?

Forgive me, but just claiming "we certainly would not expose your patient's data" is hollow at best - I take the responsibility for protecting my patient's health information very seriously, as do most physicians, and it is ultimately our responsibility to do no harm in that regard.

Not saying this is true of you guys, but there are a lot of incentives out there for "mining" and even selling health info. At the very least, storing health data on multiple, geographically disparate servers, logging access, retention policy, etc is a nightmare waiting to happen.

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#83

Post by kategleason »

logjam wrote: post #82
kategleason wrote: post #79

Earlier quoted context omitted.

I see. We certainly would not expose your patient's data. My reply at bottom should help clear that up for you. You forgot to mention what specialty you are?

No, actually your reply doesn't describe your security practices at all. Why are you retaining live data at all? Forgive me, but just claiming "we certainly would not expose your patient's data" is hollow at best - I take the responsibility for protecting my patient's health information very seriously, as do most physicians, and it is ultimately our responsibility to do no harm in that regard. Not saying this is true…

You forgot to mention what specialty you are? Take a look at our privacy, terms of service, and security pages to answer the rest of your questions above. If you do not think the service is useful then you don't need to use it. That's the beauty of the free market. One man's junk is another man's treasure.

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#84

Post by [deleted] »

kategleason wrote: post #79
logjam wrote: post #77

Earlier quoted context omitted.

Many many. I just discussed this with our office manger - checking eligibility is not a problem for us (nor would it be for most practices in my opinion) using web services already in place....and especially not free vs a dollar per 20 queries. I'm not actually a fan of insurance companies, but please explain why I would want to pay for the hassle of dealing with Yet Another third-party and at the same time expose my…

I see. We certainly would not expose your patient's data. My reply at bottom should help clear that up for you. You forgot to mention what specialty you are?

[deleted]

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#85

Post by logjam »

kategleason wrote: post #83
logjam wrote: post #82

Earlier quoted context omitted.

No, actually your reply doesn't describe your security practices at all. Why are you retaining live data at all? Forgive me, but just claiming "we certainly would not expose your patient's data" is hollow at best - I take the responsibility for protecting my patient's health information very seriously, as do most physicians, and it is ultimately our responsibility to do no harm in that regard. Not saying this is true…

You forgot to mention what specialty you are? Take a look at our privacy, terms of service, and security pages to answer the rest of your questions above. If you do not think the service is useful then you don't need to use it. That's the beauty of the free market. One man's junk is another man's treasure.

I'm a family medicine doc in a practice with several other docs. Why do you ask?

I already read your site's security pages, which in large measure do NOT address the questions I've asked here.

However, I believe you're right - neither I nor the software folks I consult with here in Bay Area will be interested in using your tool. Good luck to you.

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#86

Post by kategleason »

[deleted] wrote: post #84
kategleason wrote: post #79

Earlier quoted context omitted.

I see. We certainly would not expose your patient's data. My reply at bottom should help clear that up for you. You forgot to mention what specialty you are?

[deleted]

Gotcha, primary care is what I assumed. Most of the insurance company websites will give you back a basic active/inactive response along with the patient's copayment. For primary care docs this is enough (although its still annoying to go to 100+ websites if you accept a lot of insurance plans). However; for surgeons, chiropractors, massage therapists, dentists, diagnostic labs, genetic testing facilities, MRI facilities -- this basic information is not even close to enough. That's where the Eligible API comes in.

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#87

Post by logjam »

kategleason wrote: post #86
[deleted] wrote: post #84

Earlier quoted context omitted.

[deleted]

Gotcha, primary care is what I assumed. Most of the insurance company websites will give you back a basic active/inactive response along with the patient's copayment. For primary care docs this is enough (although its still annoying to go to 100+ websites if you accept a lot of insurance plans). However; for surgeons, chiropractors, massage therapists, dentists, diagnostic labs, genetic testing facilities, MRI facili…

Uh, no.

I and all physicians and our office staffs get back complete eligibility information for ALL possible care from a single query from existing insurance co queries: eligibility for all surgical, laboratory, radiological, inpatient hospitalization, partial hospitalization, psychiatric care, etc etc; along with deductible, copay, balance, etc etc.

Doctors have to refer patients around - we need to know which specialists accept what insurance and can see our patients. The insurance companies want us to know that. It's in their interest to let us know that. They let us know that. Already.

Could you explain how your query of the insurance company's information would be more complete than the insurance company's query of its own information?

On second thought, go have a nice day. I realize I am asking for technical information and getting sales spiel in return.

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#88

Post by kategleason »

logjam wrote: post #87
kategleason wrote: post #86

Earlier quoted context omitted.

Gotcha, primary care is what I assumed. Most of the insurance company websites will give you back a basic active/inactive response along with the patient's copayment. For primary care docs this is enough (although its still annoying to go to 100+ websites if you accept a lot of insurance plans). However; for surgeons, chiropractors, massage therapists, dentists, diagnostic labs, genetic testing facilities, MRI facili…

Uh, no. I and all physicians and our office staffs get back complete eligibility information for ALL possible care from a single query from existing insurance co queries: eligibility for all surgical, laboratory, radiological, inpatient hospitalization, partial hospitalization, psychiatric care, etc etc; along with deductible, copay, balance, etc etc. Doctors have to refer patients around - we need to know which spec…

No need to get rude here. My replys are sticking to facts not insults. Yes, my experience is in sales and I'm proud of it. Here's the data most interesting to our existing user base: 1) limitations (ie if the patient only has certain amount of visits per year) 2) deductible remaining 3) co-insurance responsibility 4) health spending balances 5) Coverage for specific tests/equipment/procedures: infertility, blood draws, wigs, durable medical equipment, dental crowns, etc.

Two of our largest api users built the system for: diagnostic lab order entry service and genetic testing service.

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#89

Post by kategleason »

logjam wrote: post #81
kategleason wrote: post #78

Earlier quoted context omitted.

Hey logjam! Let me know what specialty you are and how many insurance companies you currently accept when you have a minute. To answer your question: No, we do not have access now nor plan to have access in the future to claims data. The raw X12 I am referring to is a 271 format only (eligibility) and will be generated by our own sample transformation tool. However; it will be based off data passed (with stripped pat…

So actual patient data is being stored and manipulated, and manually "stripped" so that it can be posted (in effect) to the web? Again, I don't want to misunderstand you, but you feel comfortable doing this? I wouldn't. Please provide your backup, retention, deletion, access logging, etc., policies on that data you are manipulating. Am I understanding that an audit two months from now (you log your access and use of…

You're twisting my words. I'll let you refer to our terms, security and privacy for the rest of your questions.

Re: Show HN: Eligible API for 700+ Health Insurance Companies

#90

Post by DennisP »

daigoba66 wrote: post #67
DennisP wrote: post #60

Earlier quoted context omitted.

Wow. It's so weird seeing Meddata mentioned and described as one of the "big companies." I was Meddata's second programmer, and built their eligibility system. I wrote their edi parser in five pages of C# code. Two of us built an entire eligibility and referral system, and took the company from nothing to profitability in five years. Then I moved on. I still visit them from time to time, and although Transunion owns…

That's pretty crazy. I think I consider Meddata to be such a big player because of their extensive payer list. Also, we use Meddata as a "backup" route for when our more direct (and free) connections are unavailable. I'm curious to learn more about the history of the company. From my experience the software isn't necessarily the hard part. The hard part is setting up all of the trading partner relationships with paye…

Yep, that was the hard part. Our sales team was three people, including the CEO, and they also had to sell the product to providers. Somehow they managed.

We actually started with referrals. Providers were filling out paper forms and faxing them. Every payer had its own rules, its own identifiers for providers, its own forms. We put everything on a website and reduced a ten-minute process to thirty seconds. We got our first paying customers in 1999.

Trouble was, support was killing us. By 2001 it was starting to look like we wouldn't make it. Then we added eligibility, and it turned out to be insanely profitable. We started by getting payers to give us their entire customer lists, then added edi, plus some proprietary APIs some of them had. At that point, HIPAA hadn't fully kicked in and payers were still implementing X12.

In 2003 we started to break even, and I moved to our parent company to start another project. Meddata bought a couple other companies, then a couple years ago Transunion bought Meddata. I don't know for how much, but Meddata was making a lot of money by then with a team not much bigger, so it had to be a lot.

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