DCS has in-depth experience in HIPPA EDI. We are your resource that is immediately available to help with support and training. Our decades of experience can help you find the solutions that are most appropriate in your situation and how to apply them quickly.

Overview

A large part of the HIPAA challenge is providing secure, reliable, accurate, and economical document exchange with payers and agencies. Integration is a significant task. EDI X12N structures are complex and difficult to tackle. For example, user exits and scripts are frequently used.

HIPPA EDI too often is an afterthought during implementation, or comes up suddenly as an “on demand” project requested by a key payer that needs to be completed yesterday. In both scenarios you are forced to piece together a workable solution. This is something that you must do well and ensure that best business practices are followed, since more EDI demands will likely be built on this foundation.

Document exchange is a significant portion of the HIPAA challenge and a highly technical activity. Implementing the appropriate EDI and AS2 applications for your business is a key to HIPAA compliance. Once application installation has occurred, solid development and testing practices must be followed to ensure successful, prompt, and accurate translation of the medical claims.

Technical Review

When discussing document exchange the three areas of concern for HIPAA are document formats and communication protocols.

• The ANSI X12N standards are the guidelines used for document format definitions.
• HL7 standards govern electronic medical records.
• EDI INT AS2 standards outline the protocol required by HIPAA for secure data transmission.

An example of a document exchanged is a submission of a claim to a payer. The Health Care Claim document format is the Transaction Set 837. The claim is transmitted by secure Internet. (The transmission is secure due to the exchange of certificates, encryption of the message, connection filtering and more.) As exchange occurs without manual intervention, the process must have extensive controls. Thus, EDI Integration is a combination of document format, data transmission, and process management.

A typical development scenario would include selecting three payers, as variation within the standard is permitted.

1. From each payer, obtain specifications (documents expected, EDI and AS2 specifications, code lists, and the testing process).

2. The project plan is drafted and reviewed with I.T. and A.R. staffs.

3. The appropriate resources are identified and acquired and deliverables are set.

DCS' implementation, planning and development experience shows the primary snags that arise during this type of project are:

• Substantial delays or re-development occurs during testing with Trading Partners because of inaccurate or underdeveloped unit test plans during internal testing. This most often occurs because the looping structure of EDI documents is not understood by the person developing the translation.
• Gap analysis is not completed, delaying a project because data required to be sent to the Trading Partners are not in the application tables or similarly no fields are available for data received.
• Cross-reference data is not defined appropriately. This often occurs because the developer is not familiar with the actual business practices of your organization and makes incorrect assumptions.
• Data transmission is halted because of network and Internet security.
• Lack of knowledge transfer due to I.T. turnover.
• Inadequate EDI support from application vendors.

You should also know that HIPAA required EDI data is also frequently sent to a database instead of a PMS. Several DCS customers have moved summary data into/out of Microsoft SQL Server^TM or Oracle 11i^TM databases for subsequent processing such as reporting. DCS role is to help with data table design for EDI data and then map the data into a database. Frequently, DCS customers can save development cost by doing the reporting themselves after DCS programs to load the tables. Working jointly processes are swift and reliable.

Conclusion

Since integration is not trivial, we recommend DCS GROW™ Development Services. It is founded upon DCS' many years experience in EDI across the nation. Our sound methodologies ensure the implementation occurs smoothly. The components (EDI and AS2) can be orchestrated more harmoniously with expertise at hand. Since providers need to be self-reliant and cost conscious, doing EDI with an expert that wants to help you improve your skills makes sense. And, to become more self-reliant you may wish to consider our DCS Elite™ HIPAA EDI Training.

From education, to integration, to remote support, to user training; DCS offers the array of support needed for a solution to the HIPAA challenge. Using a seasoned expert who knows EDI and AS2 will save you time and headaches. Your first step is easy, email DCS for your Free Assessment.