Transactions and Code Sets The Unfinished Business

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Transactions and Code SetsThe Unfinished Business

• Telecommunication and HIPAA
• Issues, Concerns, Recommendations
• Chris Stahlecker
• Christine.Stahlecker_at_ctghs.com
• March 13, 2002

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Telecommunication and HIPAA

• The HIPAA regulations are silent on standardizing
  telecommunication methods.
• Discussion points
• Current State
• Desired State
• Gaps to fill
• Recommendations

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Current State Overview
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Telecomm Issues Current State

• HIPAA requires batch file transfer.
• HIPAA does not specify any standard telecomm
  protocol.
• Payers have selected the current, in-use
  capabilities, interactive and batch.
• Payers have been silent on protocol changes for
  existing or new transactions.
• Medicare says no to using the open internet.

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Telecomm Issues Desired State

• Convenience of Open EDI.
• Security and speed of dedicated line.
• Cost-savings of the internet.
• Seamless applications integration.

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Industry Trend Desired State Overview
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Getting Back To The Business Office...
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Telecomm Issues Gaps To Fill

• Practical Perspective
• Providers internet access is not through
  Practice Management (PM) products.
• PM and Service Vendors are not offering the new
  transactions.
• Providers do not have resources/staff to
  implement anything beyond what their PM vendor
  supplies.

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Telecomm Issues Gaps To Fill

• Practical Perspective
• Methods to access payers new transactions are
  inconsistent.
• Trading Partner and/or EDI Agreements
  inconsistently used/required.
• Providers may need to receive inquiries or
  requests for information and therefore need
  appropriate security.

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Telecomm Issues Gaps To Fill

• Practical Perspective
• Payers network services are sized for claim and
  remittance.
• Consider transaction volume increase.
• Consider interactive transaction increase.
• Payers security systems often use logon and
  password. Consider implications of time-out,
  password re-sets, providers employee turnover,
  role-based access.
• Payers security often based on Data Set Names for
  each transaction. Where are the requirements?

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Telecomm Issues Gaps To Fill

• Technical Perspective
• Establish an inventory of connectivity and
  transport protocols currently used.
• Define the use, if any, of Identifiers as
  parameters for Routing.
• Define acceptable methods for Routing
• Envelope (ISA/IEA)
• Transaction (Table 1) data manipulation
• Other
• Define the mechanism for distributing this
  information to Covered Entities

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Recommendations

• Focus on mission critical transactions.
• Follow the WEDI SNIP Transaction Sequencing
  proposal version 2.
• Focus on batch transactions over existing
  networks using Payers defined security.
• Consider using a Clearinghouse where direct
  point-to-point is not offered.
• Sectors of the industry are unaware of the
  complexities and may have omissions in their test
  plans. Check this as you prepare your Extension
  Request.

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Recommendations

• Pay attention to emerging technologies and
  industry leaders (subscribe to listservs).
• Include internet access for Providers business
  office personnel in your strategic plan.
• Include internet access for Provider and Payer
  medical records personnel in your strategic
  plan.
• Aggressively persuade PM and Service Vendors to
  include the new transactions.
• Plan to monitor/manage the exceptions.

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Recommendations
Participate or at least monitor activities
of The WEDI/AFEHCT Health Care Communications
Interoperability Work Group Http//SNIP.WEDI.ORG
/listserv/ Under Transactions, select Routing and
Sign Me Up!
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Useful Links

• http//snip.wedi.org/
• subscribe to routing_at_wedi.org
• http//www.wedi.org/
• http//www.afehct.org/security.asp
• http//www.healthkey.org/library.htm
• http//www.oasis-open.org/committees/ebxml-cppa/
  documents/presentations/index.shtml
• download or read ebXML version 1.0 CPP-CPA.pdf
• http//lists.oasis-open.org/archives/ebxml-cppa/
• http//lists.ebxml.org/archives/ebxml-dev
• http//www.novannet.com/wedi/

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