slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
V608 HIPAA Accelerator Jump Starts HIPAA EDI Implementations PowerPoint Presentation
Download Presentation
V608 HIPAA Accelerator Jump Starts HIPAA EDI Implementations

Loading in 2 Seconds...

play fullscreen
1 / 37

V608 HIPAA Accelerator Jump Starts HIPAA EDI Implementations - PowerPoint PPT Presentation


  • 83 Views
  • Uploaded on

V608 HIPAA Accelerator Jump Starts HIPAA EDI Implementations. Nicki Lelis Product Manager eBusiness Division Nicki.lelis@sybase.com. HIPAA Accelerator Jump Starts HIPAA EDI Implementations. Topics Sybase product overview Overview of Health Insurance Portability and Accountability Act

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'V608 HIPAA Accelerator Jump Starts HIPAA EDI Implementations' - clem


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

V608 HIPAA Accelerator Jump Starts HIPAA EDI Implementations

  • Nicki Lelis
    • Product Manager
    • eBusiness Division
    • Nicki.lelis@sybase.com
hipaa accelerator jump starts hipaa edi implementations
HIPAA Accelerator Jump Starts HIPAA EDI Implementations

Topics

  • Sybase product overview
  • Overview of Health Insurance Portability and Accountability Act
  • What is Sybase’s HIPAA Accelerator
  • How Sybase’s HIPAA Accelerator jump starts HIPAA EDI Implementations
hipaa accelerator jump starts hipaa edi implementations1
HIPAA Accelerator Jump Starts HIPAA EDI Implementations

Topics

  • Sybase product overview
  • Overview of Health Insurance Portability and Accountability Act
  • What is Sybase’s HIPAA Accelerator
  • How Sybase’s HIPAA Accelerator jump starts HIPAA EDI Implementations
sybase e business platform comprehensive modular integrated and open
Sybase e-Business PlatformComprehensive,Modular, Integrated and Open

Enabling Your

Customers

Empowering

Your Enterprise

Enriching B2B Interactions

Trding

Partners

Customers

Enterprise

Access

Power

Designer

Enterprise Portal - Web & Mobile Access

Integrate

Process

Server

Biz

Tracker

Integration

Server

Application

Adapters

Web

Services

Develop

Transact

Java IDE

Application

Server

Business

Intelligence

Replication

Database

Metadata Repository - Configuration

Security - Install - Management

SYBASE e-Business Platform

sybase e business platform support for web services

Power

Designer

Enterprise Portal - Web & Mobile Access, Openbiz

Process

Server

Biz

Tracker

Integration

Server

Application

Adapters

Web

Services

Java IDE

Application

Server

Business

Intelligence

Replication

Database

Metadata Repository - Configuration

Security - Install - Management

SYBASE e-Business Platform

Sybase e-Business PlatformSupport for Web Services
  • Simple Web Services
  • Defined as: UDDI, WSDL, SOAP
  • Supported through
  • EAServer
  • PowerDesigner
  • Collaborative Web Services
  • Defined as: B2B, RosettaNet, ebXML
  • Supported through:
  • Web Services Integrator
  • OpenBiz
sybase e business platform
Sybase e-Business Platform

Access

Power

Designer

Enterprise Portal - Web & Mobile Access

Integrate

Process

Server

Biz

Tracker

Integration

Server

Application

Adapters

Web

Services

Develop

Transact

Java IDE

Application

Server

Business

Intelligence

Replication

Database

Metadata Repository - Configuration

Security - Install - Management

SYBASE e-Business Platform

hipaa accelerator jump starts hipaa edi implementations2
HIPAA Accelerator Jump Starts HIPAA EDI Implementations

Topics

  • Sybase product overview
  • Overview of Health Insurance Portability and Accountability Act
  • What is Sybase’s HIPAA Accelerator
  • How Sybase’s HIPAA Accelerator jump starts HIPAA EDI Implementations
slide8

HIPAA

Health Insurance Portability and Accountability Act of 1996

Title I

Title II

Title III

Title IV

Title V

Fraud & Abuse

Medical Liability Reform

Administrative

Simplification

Insurance

Portability

Tax Related

Health Provision

Group Health

Plan Requirements

Revenue

Off-sets

Privacy

Security

EDI

Transactions

Code Sets

Identifiers

administrative simplification components of hipaa
Administrative Simplification Components of HIPAA

Electronic Transactions, Unique IDs, Code Sets

Implementation Standards used for the electronic transmission of specific health care transactions

slide10

Why HIPAA? –

“Simplify the Administration of Health Insurance”

  • Reduce Direct and Overhead Costs
    • Reduce the Accounts Receivable Cycle
    • Improve Accuracy
    • Reduced Data Entry Time
    • Smaller/Faster Transmissions at Lower Cost
    • Reduce/Eliminate Rework
    • Avoid/Reduce Data Entry FTE
    • Reduce Operational Costs (office supplies, postal costs and telephone charges)
slide11

Why HIPAA? –

“Simplify the Administration of Health Insurance”

  • Improve Process that directly impacts healthcare stakeholders -
    • Improved patient, provider and payer support
    • Efficient information delivery
    • Improved quality
    • Fosters “good will” with patients
    • Fosters closer working relationships between organizations
slide12

Providers, Payers, Clearinghouses

  • All must comply with the mandates of HIPAA Administrative Simplification with the following exceptions:
    • Providers who wish to conduct transactions via paper may continue to do so and avoid HIPAA compliance mandates*
    • Employers, Workers Compensations Plans, Life Insurance Plans not under HIPAA jurisdiction
    • * Under ASCA, Medicare will require electronic claim submission by 10/16/03 for providers of a certain size. Other payers may also choose to refuse paper transactions in the future.
slide13

What happens if I do not comply?

  • Penalties for transaction non-compliance specified in the Act:
    • “not more than $100 for each such violation, except that the total amount imposed on the person for all violations of an identical requirement or prohibition during a calendar year may not exceed $25,000”
slide14

What happens if I do not comply?

  • Penalties for wrongful disclosure of individually identifiable health information specified in the Act:
    • Fine of not more than $50,000, not more than 1 year imprisonment
    • False pretenses, fine of not more than $100,000, not more than 5 years imprisonment
    • Commercial advantage, personal gain, malicious harm, fine of not more than $250,000, not more than 10 years imprisonment
status of the hipaa regulations
Status of the HIPAA Regulations
  • TRANSACTIONS
  • Final Rule was made effective 10/16/00
  • Original Compliance date 10/16/02
  • ASCA 1-yr Extension date 10/16/03
  • Claim Attachment in development
  • Report of First Injury in development
slide16

Patient information

Subscriber

Patient information

Subscriber information

Premium Payment

Premium Payment

Prior AuthorizationReferral/CMN

Prior AuthorizationReferral/CMN

Claim/

Encounter

Claim/

Encounter

Claim Status

Claim Status

HIPAA X12N Transactions

Payer

Provider

Eligibility Inquiry 270

Eligibility Response 271

Sponsor

Enrollment 834

Request for Review 278

Premium Payment 820

Review Response 278

Claim/Encounter 837

Remittance Advice 835

Request Additional

Information 277

Attachments 275/HL7

Additional Information

275/HL7

Status Inquiry 276

Status Response 277

hipaa accelerator jump starts hipaa edi implementations3
HIPAA Accelerator Jump Starts HIPAA EDI Implementations

Topics

  • Sybase product overview
  • Overview of Health Insurance Portability and Accountability Act
  • What is Sybase’s HIPAA Accelerator
  • How Sybase’s HIPAA Accelerator jump starts HIPAA EDI Implementations
what is sybase s hipaa accelerator
What is Sybase’s HIPAA Accelerator

Sybase’s HIPAA Accelerator jump starts HIPAA implementations by:

  • Predefined Standards that reflect the implementation guides to jump start data transformation maps
  • Providing compliance maps to verify the EDI data against the HIPAA implementation guides
slide19

HIPAA – X12 Cross Reference

HIPAA Transaction ASC X12 Standard

Health Care Claim/COB

Professional X12N 837 X098

Institutional X12N 837 X096

Dental X12N 837 X097

Claim Attachment X12N 277 & 275 + HL7

Enrollment/Disenrollment X12N 834 X095

Eligibility X12N 270 & 271 X092

Premium Payment X12N 820 X061

Payment & Remittance Advice X12N 835 X091

First Report of Injury X12N 148 X086

Health Claim Status X12N 276 & 277 X093

Referral X12N 278 X094

what is sybase s hipaa accelerator1
What is Sybase’s HIPAA Accelerator

Standards

  • Reflect the structure specified in the HIPAA Implementation Guides for each transaction
    • Segment and loop sequence
    • Segment and loop occurrences
    • Segment and loop requirements
what is sybase s hipaa accelerator2
What is Sybase’s HIPAA Accelerator

Standards

  • Data element requirements
what is sybase s hipaa accelerator3
What is Sybase’s HIPAA Accelerator

Compliance Maps

  • Verify the structure for each transaction specified in the HIPAA Implementation Guides
    • Segment and loop sequence
    • Segment and loop occurrences
    • Segment and loop requirements
what is sybase s hipaa accelerator4
What is Sybase’s HIPAA Accelerator

Compliance Maps

  • Verify data element conditions
what is sybase s hipaa accelerator5
What is Sybase’s HIPAA Accelerator

Compliance Maps

  • Verify code lists as defined in the HIPAA Implementation Guides
what is sybase s hipaa accelerator6
What is Sybase’s HIPAA Accelerator

Compliance Maps

  • Contain gray box rule logic
what is sybase s hipaa accelerator7
What is Sybase’s HIPAA Accelerator

Also contains:

  • Business Case Scenarios
  • Test Data
hipaa accelerator jump starts hipaa edi implementations4
HIPAA Accelerator Jump Starts HIPAA EDI Implementations

Topics

  • Sybase product overview
  • Overview of Health Insurance Portability and Accountability Act
  • What is Sybase’s HIPAA Accelerator
  • How Sybase’s HIPAA Accelerator jump starts HIPAA EDI Implementations
how sybase s hipaa accelerator jump starts hipaa edi implementations
How Sybase’s HIPAA Accelerator jump starts HIPAA EDI Implementations

Map Development:

  • Provides standard definitions for each transaction per the HIPAA implementation guides
  • Identifies required, situational and not used data elements for each transaction
  • Provides X12 based code lists with the values specified in the HIPAA implementation guides for each transaction
how sybase s hipaa accelerator jump starts hipaa edi implementations1
How Sybase’s HIPAA Accelerator jump starts HIPAA EDI Implementations

Compliance Maps can be easily modified:

  • To add site specific edits
  • To add external code list lookups
how sybase s hipaa accelerator jump starts hipaa edi implementations2
How Sybase’s HIPAA Accelerator jump starts HIPAA EDI Implementations

In production:

  • Compliance maps to validate X12 data against the HIPAA implementation
  • Generation of the X12 997 transaction to report results back to the originator
  • The ability to process only the data that passes compliance maps through data transformation maps