Electronic Data Interchange Assessment Strategies Application Systems Trading Partners Business Associates Application Vendors The Standards Application.

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Presentation transcript:

Electronic Data Interchange Assessment Strategies Application Systems Trading Partners Business Associates Application Vendors The Standards Application System Modifications Testing vs. Certification Implementation

Application Systems What is an Application System? Inventory Application Systems Determine Owner –In-house vs. Vendor Supported Assess Application System –Transactions, Medical Code Sets, National Identifiers Utilize ‘System Functionality Statement’ as a Starting Point

Trading Partners What is a Trading Partner? Inventory Trading Partners Review Trading Partner Agreements Form New Trading Partner Agreements WEDI/SNIP White Paper

Business Associates What is a Business Associate? Inventory Business Associates Review Business Associate Agreements –Modify Agreements for HIPAA Form New Business Associate Agreements Follow-up with Business Associate –Company HIPAA Statements and Status –Compliance Strategies

Application Vendors Review Application Vendor Contracts –Governmental Mandates –Maintenance Fees –Version Upgrade vs New Development Follow-up with Application Vendor –Company HIPAA Statements and Status –Compliance Strategies

The EDI Standards What is a Standard? Who has to use the Standards? When are the Standards Required?

The EDI Standards Health Care Eligibility Benefit Inquiry and Response ASC X12N 270/271 (004010X092) Health Care Claim Status Request and Response ASC X12N 276/277 (004010X093) Health Care Services Review Request and Response ASC X12N 278 (004010X094) Benefit Enrollment and Maintenance ASC X12N 834 (004010X095)

The EDI Standards Payroll Deducted and Other Group Premium Payment for Insurance Products ASC X12N 820 (004010X061) Health Care Claim –Institutional (UB92) ASC X12N 837 (004010X096) –Professional (HCFA1500) ASC X12N 837 (004010X098) –Dental ASC X12N 837 (004010X097) Health Care Claim Payment/Advice ASC X12N 835 (004010X091)

The EDI Standards Washington Publishing Company ANSI ASC X12N HIPAA Implementation Guides

Application System Modifications Assess Further at Data Element Level –Compare Data Elements to the Standards Mandatory Situational Conditional –Compare Data Element Attributes –Numeric, Alpha, Alphanumeric, Size –Review Business Needs ‘have’ vs. ‘don’t have’ vs. ‘cannot have’

Application System Modifications Determine Business Specifications –How to do Business the HIPAA way Business and IT Unite –IT cannot ‘Fix’ HIPAA »Require Business Decisions Involve All Interested Parties –Application System Users »Management »Worker Bees

Testing vs. Certification “Those attempting to ‘self-certify’ are simply testing themselves from beginning to end.” Testing –Application Systems Internal –Application to Application (A2A) »Files, Program Code, Edits, Reports, Financials, etc... External –Business to Business (B2B) »Transactions

Testing vs. Certification Certification –Electronic Healthcare Network Accreditation Commission (EHNAC) –Claredi WEDI/SNIP White Paper

Implementation Trading Partner Agreements In Place Business Associate Agreement In Place Application Systems HIPAA Compliant Training Completed and Ongoing Internal Testing Completed External Testing Completed HIPAA Transaction Certification Obtained Now to the Second Phase