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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?

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electronic data interchange assessment strategies
Electronic Data Interchange Assessment Strategies
  • Application Systems
  • Trading Partners
  • Business Associates
  • Application Vendors
  • The Standards
  • Application System Modifications
  • Testing vs. Certification
  • Implementation
application systems
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
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

business associates
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
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
The EDI Standards
  • What is a Standard?
  • Who has to use the Standards?
  • When are the Standards Required?
the edi standards1
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 standards2
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 standards3
The EDI Standards

Washington Publishing Company

ANSI ASC X12N HIPAA

Implementation Guides

http://hipaa.wpc-edi.com/HIPAA_40.asp

application system modifications
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 modifications1
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
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 certification1
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

implementation
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
hipaa pmo edi team
HIPAA PMO EDI Team

Cynthia Wagoner, PMO EDI Lead

Stephen Fraser, PMO EDI Technical Writer

Marilyn Tarkalson, PMO Administrative Assistant

http://dirm.state.nc.us/hipaa/newsite/focusgroup/edi/edi.html

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