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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

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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

    • cynthia.wagoner@ncmail.net

    • 919-661-5883

      Stephen Fraser, PMO EDI Technical Writer

    • stephen.fraser@ncmail.net

    • 919-661-5892

      Marilyn Tarkalson, PMO Administrative Assistant

    • marilyn.tarkalson@ncmail.net

    • 919-661-5897

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


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