Minnesota HIPAA Collaborative

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Minnesota HIPAA Collaborative

• Overview and 2004 Direction
• April 16, 2004
• www.mnhipaacollab.org

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Agenda

• Origins
• Membership
• Goals
• Governance
• Website and Tools
• Free Testing
• 2004 Plan
• 270/271 Enhanced Eligibility Approach

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MN HIPAA Collaborative Origins

• Created out of HIPAA implementation discussions
  among Collaborative members in 2000.
• CIOs from each founding member organization
  created a steering committee to set goals and to
  provide resources for achieving those goals.
• Initial collaborative work effort started with a
  small group of health care companies so that work
  could proceed quickly.

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MN HIPAA Collaborative Membership

• Allina Hospitals and Clinics
• Blue Cross and Blue Shield of Minnesota
• Fairview Health Services
• HealthPartners
• Mayo Foundation
• Medica
• Park Nicollet Health Services
• PreferredOne
• Minnesota Department of Human Services
  (non-voting member)

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MN HIPAA Collaborative Primary Goals

• Assist Minnesota healthcare organizations
  (providers, health plans, clearinghouses) achieve
  timely and cost-effective implementation of the
  HIPAA transactions, code sets, and identifier
  standards
• Promote HIPAA transaction readiness
• Identify leading practices
• Recommend solutions through a public web site
• Offer an independent testing solution to
  healthcare organizations in the Minnesota
  community

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MN HIPAA Collaborative Governance

• Independent healthcare committee, not associated
  with any professional organization
• Not a legal entity
• Scope of activities limited to HIPAA
  transactions, code sets, and unique identifier
  standards
• Membership -- Volunteers from invited provider
  and health plan organizations
• Operating Costs -- shared by founding members
• Administrative Support --- Rx2000
• Community Testing Service -- Edifecs

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MN HIPAA Collaborative Governance

• Organization Structure
• Steering Committee
• CIOs from founding members
• Provides overall direction and guidance
• Approves funding requests
• Operations Committee
• Develops strategy and plans
• Monitors workgroup efforts and progress
• Approves all final deliverables
• Workgroups
• Develops detail work plans and deliverables
• Reports to Operations Committee

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MN HIPAA Collaborative Governance
Current Workgroups
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www.mnhipaacollab.org

• Getting Started
• Transactions Companion Guides
• Transaction Readiness Schedules and Contacts
• Security/Connectivity Matrix
• Testing Tools
• Links to member web sites
• News and Events
• Resource Links
• Register for updates
• Register for free testing

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MN HIPAA Collaborative Tools
Work products will help the Minnesota healthcare
community prepare for HIPAA testing and
implementation with their trading partners. Tools
include

• A free transaction testing tool
• Leading practices for security and connectivity,
  testing and data requirements
• Transaction testing and implementation schedules
  for major trading partners
• Transaction Companion Guides that include payer
  and provider rules and edits for transactions

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Targeted Transactions

• 837- Professional and Institutional Claims
• 835- Remittance Advice
• 270/271- Eligibility Inquiry/ Response
• 276/277- Claims Status Inquiry/ Response
• 278- Referral/Authorization

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Free Testing

• Free testing is a service offered by the MN HIPAA
  Collaborative Powered by Edifecs. The free
  testing allows validation of HIPAA transactions
  based on WEDI-SNIP standard types 1-7 for HIPAA
  mandated ANSI X12 version 4010A1 transactions.

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WEDI-SNIP Types 1-7

• Type 1 EDI syntax integrity testing
• Type 2 HIPAA syntactical requirement testing
• Type 3 Balancing
• Type 4 Situation testing
• Type 5 External code set testing
• Type 6 Product types or line of services
• Type 7 Implementation Guide-Specific Trading
  Partners

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MN HIPAA Collaborative 2004 Plan

• Transactions
• Claim attachments (275) - subject to CMS
  publication of final rule
• Transaction acknowledgements and error reports
• New versions of current transactions
• Unknown when HHS will mandate new versions
• Follow transaction development through X12
  process
• Community framework enhanced transaction
  processing
• 270/271 Eligibility

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MN HIPAA Collaborative 2004 Plan

• Transactions (continued)
• Community testing service (Edifecs)
• Free testing services
• Monitor community progress
• Unique Identifiers
• NPI - National Provider ID
• HPI - Health Plan ID -- subject to CMS
  publication of final rule

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Enhanced Eligibility 270/271

• Initial Approach
• Low cost with minimum operating overhead --
  leverage what has already been built
• Information is based on HIPAA 270/271 format and
  field definitions
• Payers will maintain separate application/data
  solutions accessible by provider participants
• Solutions will conform with HIPAA Privacy and
  Security regulations
• Invitation for participation extended to
  additional providers and payers (Total entities
  -- 15)

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Enhanced Eligibility 270/271

• Requirement Topics
• Data
• Eligibility Search Process
• Connectivity
• Data
• Provider Wish List created by providers
• Initial implementation is limited to high
  priority set of data elements
• Key Issue
• Payer ability to populate all elements during
  initial implementation

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Enhanced Eligibility 270/271

• Provider Wish List -- High Priority Elements
• Sub. ID Patient ID
• Sub. First Name Patient First Name
• Sub. Last Name Patient Last Name
• Sub. DOB Patient DOB
• Sub. Insurance Group Number Patient Coverage
  Effective Date
• Other Payer Name Patient Coverage End Date
• Insurance Type Code
• Plan or Product Description
• Coverage Type
• Co-Insurance
• Co-Pay
• Deductible

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Enhanced Eligibility 270/271

• Eligibility Search Process
• Search elements supported by HIPAA 270
  transaction
• 1. Patient ID
• 2. Patient First Name
• 3. Patient Last Name
• 4. Patient DOB
• 5. Eligibility inquiry date
• Elements can be submitted in various combinations
• Elements submitted must be able to match on
  unique individual, or a not found will be
  returned
• Current Payer search processing is similar, but
  not necessarily identical

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Enhanced Eligibility 270/271

• Connectivity
• Types of connectivity to be supported
• 1. Batch -- (HIPAA requirement)
• 2. Real-time /asynchronous
• 3. Real-time /synchronous
• Payers may not support all connectivity types in
  2004
• 1. Dependent upon funding and/or business
  strategy
• 2. Dependent upon finalization of connectivity
  protocols among MN Collaborative members
• 3. Target for definition of standard community
  communication protocols --- May 2004

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How to Contact Us

• Administrative support team at RX2000 Institute
• info_at_mnhipaacollab.org
• 952-595-9551-Phone
• 952-513-1544-Fax
• Mail
• Minnesota HIPAA Collaborative
• c/o RX2000
• 11824 Wayzata Blvd
• Minnetonka, MN 55305

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Questions