Larry Watkins Vice President & COO, Claredi Corporation Co-Chair, ASC X12N Health Care Task Group Co-Chair, WEDI Strategic National Impl. Process (SNIP)

Slides:



Advertisements
Similar presentations
HIPAA X12 Transactions and Code Sets Testing and Certification The HIPAA Colloquium at Harvard University August 20, 2002 Kepa Zubeldia, MD, Claredi.
Advertisements

1 Medicare HIPAA Issues October, 2002 Kathy Simmons Centers for Medicare & Medicaid Services.
1 Health Insurance Portability and Accountability Act of 1996 IS&C Expo October 16 & 17, 2002 John Wagner Governor’s Office of Technology.
Health Care Claim Preparation & Transmission Chapter 8 OT 232 Lecture 2 1OT 232 Ch 8 lecture 1.
Electronic Submission of Medical Documentation (esMD) Face to Face Informational Session esMD Requirements, Priorities and Potential Workgroups – 2:00pm.
Lessons Learned from the 5010 Conversion to take into ICD-10
 5010 Purpose and Requirements  County Testing  Implementation & Schedule Constraints.
HIPAA Administrative Simplification Final Rule for Transactions Code Sets Stanley Nachimson
Provider Perspective: Anticipated Benefits; Concerns; Alternative Approaches; Timeline and Budgeting for Implementation Jim Whicker, CPAM Intermountain.
An Approach to 5010 My Experience Tim Bavosi, HRS.
1 Operating Rules Status NCVHS Subcommittee on Standards December 3, 2010 Updated on enhancements to Operating Rules for Eligibility and Claim Status.
Segment Five: Provider Communication Idaho ICD-10 Site Visit Training segments to assist the State of Idaho with the ICD-10 Implementation January 26-27,
Lesson 4 Reading 837 Error Reports and Making Corrections.
HIPAA TRANSACTIONS HIPAA Summit IV 2002 UPDATE. HHS Office of General Counsel l Donna Eden l Office of the General Counsel l Department of Health and.
Electronic Data Interchange Assessment Strategies Application Systems Trading Partners Business Associates Application Vendors The Standards Application.
5010 and ICD-10 Are you preparing?. Who are Covered Entities? Health care provider that conducts certain transactions in electronic format Clearinghouse.
HIPAA Medicare FFS Issues Fourth National HIPAA Summit April 26, 2002 Janis Nero-Phillips Director OIS/Division of Data Interchange Standards.
Washington Health Benefit Exchange C ARRIER T ESTING O VERVIEW & 834 DRAFT C OMPANION G UIDE R EVIEW February 27, :00-3:00 PM.
Facilitators: Kit Cairns, WIITTS Karen Navarro, University of WI Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and CCRS Overview of 5010 and ICD-10:
5 TH National HIPAA Summit HIPAA Vendor Readiness SIEMENS/HDX Presentation 1 November 2002 Don Bechtel HDX Compliance Officer Co-chair WEDI SNIP Transactions.
ANSI 5010 Deidre Lawson Fryfogle- Product Manager.
1 Analysis of Proposed Rules regarding Transactions/Code Sets National HIPAA Audioconferences September 3, 2008.
Presented by Joan Kossow Data Compliance Manager The Changing Face of Claims Processing &
PricewaterhouseCoopers Transaction Compliance Date Extension & Privacy Standards NPRM Audioconference April 19, 2002 HIPAA Administrative Simplification.
Kepa Zubeldia, M.D. Claredi Converging HIPAA Transaction Requirements Lowering the Cost of Implementation by Reducing Variability.
Preparing an ASCA Compliance Plan. Then what? HIPAA Summit IV Washington DC, April 25, 2002 Kepa Zubeldia, M.D.
Workshop 2.01 Transactions and Code Sets: The Unfinished Business Contingency Planning Chris Stahlecker, Principal Consultant Computer Task Group WEDI.
Facilitator: Kit Cairns, WIITTS 5010 Working Session It's Time to Get Techie.
File: 06_RETS_Implementation Issues.PPT 1 RETS Implementation Issues  Business Case  Project Preliminaries  Resource Identification  RETS Service Supplier.
HIPAA Transactions: The End Game HIPAA Summit IV Washington DC, April 26, 2002 Kepa Zubeldia, M.D.
HIPAA--The Medicare Experience September, 2002 Kathy Simmons Technical Advisor OIS/Division of Data Interchange Standards.
© 2002 Walt Culbertson 1 Walt Culbertson, Chair Southern HIPAA Administrative Regional Process (SHARP) October 31, 2002 Roundtable on State HIPAA Compliance.
FleetBoston Financial HIPAA Privacy Compliance Agnes Bundy Scanlan Managing Director and Chief Privacy Officer FleetBoston Financial.
The Language of HIPAA: Deciphering the Transactions and Code Sets By Scott Drinkard, MBA and Marion Munagian, RN, BSN.
© 2003 Claredi Advanced Approaches to Transactions Testing Seventh National HIPAA Summit Baltimore, September 15, 2003 Kepa Zubeldia, M.D., Claredi.
HIPAA Vendor Readiness Siemens/HDX Audio Telecast July 24, 2002.
HIPAA Transactions Testing Update Kepa Zubeldia, M.D. September 13, 2004.
HIPAA Summit Audioconference Analysis of Addenda to HIPAA Transactions and Code Sets Rule Larry Watkins Executive Vice President, Claredi Co-chair, WEDI.
Practical HIPAA Compliance Strategies for Medical Groups, IPAs and Clinicians The Sixth Annual National HIPAA Summit March 27, 2003 Robert M. Tennant Senior.
HIPAA Summit EDI Enrollment A Manual Process in the EDI Chain Marcallee Jackson ProxyMed, Inc.
Facilitators: Kit Cairns, Dean Health Greg Margrett, Netwerkes/Ingenix.
Segment 6: Provider Communication California ICD-10 Site Visit Training segments to assist the State of California with the ICD-10 Implementation June.
Standard Unique Health Identifier for Health Care Providers April 9, th Annual HIPAA Summit Gail Kocher Highmark.
Testing for Successful Deployment: Roundtable Discussion HIPAA COW Spring Conference April 8, 2011.
Clyde Hanks, COO The Health Care Interchange of Michigan The Eight National HIPAA Summit March 7 – 9, 2004 Baltimore, MD.
HIPAA X12 Transactions Testing and Certification HIPAA Summit Audioconference, May 9, 2002 Kepa Zubeldia, M.D.
The ASCA Compliance Plans, Testing, and Transactions Deployment The Sixth National HIPAA Summit March 27, 2003 Kepa Zubeldia, MD, Claredi.
Advanced Issues in Transactions, Data Code Sets and Identifiers: Testing and Certification The Fifth National HIPAA Summit November 1, 2002 Kepa Zubeldia,
The Coming Crash? HIPAA: Transactions, Codes Sets and Identifiers (TCI) Joseph C Nichols MD Paladin Data Systems Sept 16, 2003.
CMS HIPAA Outreach: How You Can Benefit Larry Hyatt, Titan Systems.
HIPAA Yesterday, Today and Tomorrow? Dianne S. Faup Office of HIPAA Standards Centers for Medicare & Medicaid Services.
Provider Perspective on Medicare’s COB Edits By George Arges.
Traveling into the Future with the 5010 Implementation Timeline HIPAA COW Spring 2009 Conference Presented by Laurie Burckhardt, WPS EDI Manager.
Improving Compliance with ISAs Presenters: Al Johnson & Pat Hayle.
Electronic Data Interchange (EDI)
Will There be a Train Wreck on October 16, 2003?
An EDI Testing Strategy
TM Workgroup for Electronic Data Interchange.
HIPAA Transactions and Code Sets Implementation June 6, 2003
TM Workgroup for Electronic Data Interchange.
Transaction Compliance by October 16, 2003?
Workshop 2.01 TCS: Unfinished Business
Regulatory Policy Analyst McKesson Information Solutions
The Centers for Medicare & Medicaid Services
Are Stakeholders Prepared? Results from the WEDI Survey Conducted in
The Centers for Medicare & Medicaid Services
Converging HIPAA Transaction Requirements
The Importance of April 16, 2003: Where You Should be in HIPAA Data Code Sets/Transactions Testing and Compliance Presented by: Steven S. Lazarus, PhD,
Electronic Data Interchange: Transactions and Security
Electronic Data Interchange: Transactions and Security
Presentation transcript:

Larry Watkins Vice President & COO, Claredi Corporation Co-Chair, ASC X12N Health Care Task Group Co-Chair, WEDI Strategic National Impl. Process (SNIP) HIPAA Transactions: Testing and Certification National HIPAA Summit Audioconference: Vendor And Clearinghouse Requirements For HIPAA Compliance

Breaking the cycle First phase: testing –Start testing as early as possible. –Confidential Testing against a neutral third party, not my trading partner. –Know where you are. Second phase: certification –Now I am really ready. –I want the world to know. –I can start engaging trading partners. Third Phase: Business to Business –Repeat for each “companion document” / TP

Testing today Find trading partner that agrees to test with you –Typically one that will eventually benefit from your transactions Send test files Get test report from trading partner Correct errors found by trading partner Repeat the cycle until no more errors

What the testing covers Telecommunications Security, authentication, access Data format issues Data content issues –Generic HIPAA requirements –Trading partner specific requirements Business rules –Some are HIPAA, some are trading partner specific requirements

Graphical view EDI Submitter contract Telecom / connectivity X12 syntax HIPAA syntax Situational requirements Code sets Balancing Line of business testing Trading partner specifics 1-2 days 2-3 weeks 3-4 weeks

The result of this testing Trading partner does not care about certain data elements –No errors reported this time Trading partner requires some data elements –Not an error for anybody else Is the error in the sender or the receiver of the transaction? –Cannot tell for sure. –Different interpretations.

Testing with multiple Trading Partners TP Specific Common in HIPAA (2-3 weeks each)

The end result of today’s method of testing Repeat the testing for each trading partner. Common HIPAA requirements tested again from scratch each time. “Statistical Testing” Never sure of whether the testing is: –Complete, Correct, Repeatable. Very time consuming, expensive, wasteful, process. Unfair cost for the “readier” partner. –They end up debugging their trading partners.

The SNIP approach Compliance testing –Your own system, independent from trading partners –Structured testing; complete testing –HIPAA Implementation Guides Business to Business testing –Assume both trading partners are already compliant. Don’t repeat the compliance testing part –Test only peculiar TP issues –Companion Documents

SNIP Compliance testing “Types” of testing recommended by SNIP: 1.EDI syntax integrity 2.HIPAA syntactical requirements Loops, valid segments, elements, codes 3.Balancing of amounts Claim, remittance, COB, etc. 4.Situational requirements Inter-segment dependencies 5.External Code sets X12, ICD-9, CPT4, HCPCS, Reason Codes, others 6.Product Type, Specialty, or Line of Business Oxygen, spinal manipulation, ambulance, anesthesia, DME, etc. 7.Trading Partner Specific (NEW) Medicare, Medicaid, Indian Health, in the HIPAA IGs.

Compliance testing Testing in both directions –Outgoing transactions –Incoming transactions Test for all SNIP test types (“levels”) HIPAA Compliance –Specific requirements in the IGs Business requirements –Fuzzy general “industry knowledge” –Companion Documents

Testing with multiple Trading Partners TP Specific Common in HIPAA (2-3 weeks each)

Certification prior to Testing with multiple Trading Partners TP Specific Common in HIPAA (2-3 weeks total)

Certification prior to Testing with multiple Trading Partners TP Specific Common in HIPAA

The ideal HIPAA scenario Trading Partner Business to Business testing Compliance testing

SNIP Compliance Testing Methodical vs. “statistical” (trial and error) testing process All types (levels) of test are required –Cannot stop at an arbitrary point Required compliance testing BEFORE starting the Business to Business testing process Recommends third party Certification of compliance

Compliance Certification Compliance testing Trading Partner Business to Business testing Compliance Certification

Compliance testing Trading Partner Business to Business testing Compliance testing Compliance Certification

Certification vs. Testing Testing is for yourself (or between yourself and your trading partners as done today?) Certification is by third party Certify once, use certification in many trading partner relationships –Simplify testing, reduce to only companion document –Reduce cost of testing phase Certification should be recognized by all trading partners Certification must be done by a neutral third party Certification process must be disclosed, verifiable, and accepted by industry

Testing –Private –For your own needs only –Test compliance –Test non- compliance –Never ending? User-defined Certification –Public statement –Also for other trading partners –Verify compliance –(Only positive assertion, no such thing as “certification of non- compliance”) –Well defined end point Certification vs. Testing

Certification Challenge Each entity has unique requirements –Commercial business, HMO, Medicare –Generalist, specialist, ambulance, anesthesiologist, chiropractor, DME, etc. A “generic” certification is meaningless What does it mean to be “certified”? Must consider submitter capabilities and receiver requirements

The “clean test” myth If a transaction has no errors, it must be “HIPAA compliant” Transaction Error Free Errors Compliant Non-Compliant Relevant Irrelevant Rational Irrational

Certify your HIPAA compliance –Indicates capabilities related to requirement to comply with the HIPAA law Certify the transaction capabilities you have demonstrated to have. Both incoming and outgoing –Transaction capabilities as groups of data that represent the data needs of a business transaction Cannot certify your ability to send/receive invalid (syntax or HIPAA) transactions Cannot certify that all your outgoing transactions will always be compliant Valid HIPAA Certification

The “vendor will fix it” myth My vendor / clearinghouse is HIPAA compliant. Why should I have to worry about it? They are going to take care of my HIPAA EDI compliance for me. –Providers and payers MUST get involved. –This is NOT an IT problem. It’s not Y2K –There are profound business implications in HIPAA.

The “Blanket Approval” myth (Is testing of the vendor/clearinghouse enough?) The issue is Provider Compliance –Provider’s responsibility to be HIPAA compliant Each Provider is different –Different provider specialty  different requirements –Different software version  different data stream and contents –Different EDI format to clearinghouse  different content capabilities –Different provider site install  different customization –Different users  different use of code sets, different data captured, different practices, etc. Vendor’s capabilities not the same as provider’s –Vendor or clearinghouse has the aggregate capabilities of all its customers –The Provider does not have all of the clearinghouse or vendor capabilities

Certification Use for Clearinghouses Work with select clients to test and certify significant clearinghouse capabilities Use certification as gap analysis before moving clients into production –Test provider implementation –New specialties, converted formats, software versions, etc. Value Add – Match capabilities of providers with payers to ensure interoperability