Electronic Data Interchange Assessment Strategies

1
Electronic Data Interchange Assessment Strategies

• Application Systems
• Trading Partners
• Business Associates
• Application Vendors
• The Standards
• Application System Modifications
• Testing vs. Certification
• Implementation

2
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

3
Trading Partners

• What is a Trading Partner?
• Inventory Trading Partners
• Review Trading Partner Agreements
• Form New Trading Partner Agreements
• WEDI/SNIP White Paper
• http//snip.wedi.org/public/articles/Trading113000
  .pdf

4
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

5
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

6
The EDI Standards

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

7
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)

8
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)

9
The EDI Standards

• Washington Publishing Company
• ANSI ASC X12N HIPAA
• Implementation Guides
• http//hipaa.wpc-edi.com/HIPAA_40.asp

10
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. dont have vs. cannot have

11
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

12
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

13
Testing vs. Certification

• Certification
• Electronic Healthcare Network Accreditation
  Commission (EHNAC)
• http//www.ehnac.org/
• Claredi
• http//www.claredi.com
• WEDI/SNIP White Paper
• http//snip.wedi.org/public/articles/testing030901
  .pdf

14
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