Presentation is loading. Please wait.

Presentation is loading. Please wait.

Regulatory Policy Analyst McKesson Information Solutions

Published byLeslie Oliver Modified over 6 years ago

Similar presentations

Presentation on theme: "Regulatory Policy Analyst McKesson Information Solutions"— Presentation transcript:

1 Regulatory Policy Analyst McKesson Information Solutions
Advanced Issues in Transactions, Data Code Sets and Identifiers: Testing and Certification Mark McLaughlin Regulatory Policy Analyst McKesson Information Solutions

2 Case Study of Clearinghouses
Clearinghouse Readiness Clearinghouse Testing and Certification Payer Readiness Payer Testing and Certification Issues HIPAA Successful Factors 12/8/2018

3 Clearinghouse Readiness
Not accommodating all transactions today Transactions most commonly accommodated: Claims Remits Eligibility Claim Status Some Referral certification and authorization Clearinghouses appear ahead of the implementation curve NDC codes Addenda items Data content still needed Verification vs. Validation 12/8/2018

4 Clearinghouse Testing and Certification
Most using at least one testing or certification service Testing with basic transactions files for Institutional and Professional claims 10-20 files for remittances 20 for eligibility Third party testing by payer trading partners is most often not required 12/8/2018

5 Payer Readiness Over 1000 payer trading partners: only 30 in testing process Payers, in general, appear to be using a phase-in approach Stage 1 – Incorporate new translator and transactions into existing process Stage 2 – Implement pseudo-compliant X12 Stage 3 – Implement HIPAA compliant X12 Many payers using a third party testing or certification service for their own internal use 12/8/2018

6 Testing and Certification Issues
Internal tests run through testing services to assist in problem finding and correction prior to payer testing. Tests sent through two similar testing services resulted in the same exact errors. No point in using both. Trading partners use the testing service to resolve interpretation issues. 12/8/2018

7 Testing and Certification Issues
Is there value in testing? Varying companion guides Differences in batching, looping, interchanges Differences in interpretation of fields Restrictions on delimiters Restrictions on field sizes Using “not used” fields still Adding values to IG internal code lists 12/8/2018

8 HIPAA Successful Factors
Factors leading to successful HIPAA compliance: Consistent interpretation in the Implementation Guides critical Buy-in of the payers to the value of the testing and certification services needed Stage 3 testing of fully compliant transactions must be done immediately 12/8/2018

9 Questions 12/8/2018

Download ppt "Regulatory Policy Analyst McKesson Information Solutions"

Similar presentations

1 Medicare HIPAA Issues October, 2002 Kathy Simmons Centers for Medicare & Medicaid Services.

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.

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.

Health Care Claim Preparation & Transmission Chapter 8 OT 232 Lecture 2 1OT 232 Ch 8 lecture 1.
Lessons Learned from the 5010 Conversion to take into ICD-10

Lessons Learned from the 5010 Conversion to take into ICD-10
Lesson 1 Overview of the 837 and 835. 2 Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you.

Lesson 1 Overview of the 837 and Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you.
 5010 Purpose and Requirements  County Testing  Implementation & Schedule Constraints.

 5010 Purpose and Requirements  County Testing  Implementation & Schedule Constraints.
HIPAA Administrative Simplification Final Rule for Transactions Code Sets Stanley Nachimson

HIPAA Administrative Simplification Final Rule for Transactions Code Sets Stanley Nachimson
Payer – Provider Interoperability Issues Created by the HIPAA Administrative Simplification Provisions MEDINF 405-DL Dave Robbins.

Payer – Provider Interoperability Issues Created by the HIPAA Administrative Simplification Provisions MEDINF 405-DL Dave Robbins.
Welcome! If you experience any technical difficulties or have any questions, please call: 978.805.4179 or This teleconference.

Welcome! If you experience any technical difficulties or have any questions, please call: or This teleconference.
837 Professional and Institutional Changes 4010A1 to 5010 Presented by John Bock.

837 Professional and Institutional Changes 4010A1 to 5010 Presented by John Bock.
1 Operating Rules Status NCVHS Subcommittee on Standards December 3, 2010 Updated on enhancements to Operating Rules for Eligibility and Claim Status.

1 Operating Rules Status NCVHS Subcommittee on Standards December 3, 2010 Updated on enhancements to Operating Rules for Eligibility and Claim Status.
Blair Elledge Quadax, Inc.. 5010 Discussion Topics Intended Purpose, Benefits, Why Change? 5010 Transactions…much more than claims Everyday Impact of.

Blair Elledge Quadax, Inc Discussion Topics Intended Purpose, Benefits, Why Change? 5010 Transactions…much more than claims Everyday Impact of.
Lesson 4 Reading 837 Error Reports and Making Corrections.

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.

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.

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.

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.

HIPAA Medicare FFS Issues Fourth National HIPAA Summit April 26, 2002 Janis Nero-Phillips Director OIS/Division of Data Interchange Standards.
WHAT'S AHEAD? Kathy Whitmire Dale Gibson February 15, 2011 HIPAA 5010, ICD-10, ACO's, VBP, HIGLAS, PECOS.

WHAT'S AHEAD? Kathy Whitmire Dale Gibson February 15, 2011 HIPAA 5010, ICD-10, ACO's, VBP, HIGLAS, PECOS.
5 TH National HIPAA Summit HIPAA Vendor Readiness SIEMENS/HDX Presentation 1 November 2002 Don Bechtel HDX Compliance Officer Co-chair WEDI SNIP Transactions.

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.

ANSI 5010 Deidre Lawson Fryfogle- Product Manager.

Similar presentations

Ads by Google