Different methods of EDI are required for pharmaceutical providers, manufacturers of medical products, and providers, such as hospitals and clinics. While the underlying concepts are similar, the EDI documents are different.

• Manufacturers use EDI for the product order-to-payment cycle. These are the familiar INbound Purchase Order, OUTbound Shipment Notice, and OUTbound Invoice; plus other documents such as Chargebacks.
• Pharmaceutical companies also use EDI for the order-to-payment cycle. Yet they must follow stringent requirements related to Lot tracing, expiration, and other controls needed for the disbursement of drugs.
• Providers use EDI for eligibility, claims, and appeals with payers such as Blue Cross. Their EDI activity is stipulated by HIPAA.

Medical Products Manufacturing

Your business is unique because the very highest quality medical product standards must be met. These high standards apply to business processes and are subject to regulation and scrutiny. Yet, customers’ requirements affect your processes. This means you must adapt your time tested processes while ensuring the cost of each process is minimized. Practically, this means process automation, so that the limited customer service staff has ample time to focus upon problems. For example, if you drop-ship to hospitals or clinics, the correct addresses (to the correct station) must be easily importable and tied to the correct bill-to distributor.

Improved process automation can be achieved by fine-tuning your existing EDI and ERP systems, especially the swift alerting of exception messages. Other unique challenges are:

• Lot tracing – sending the lot number to customers on the invoice.
• Expiration management – receiving accurate inventory reports.
• Contract administration with non-profit buying groups and government agencies.

Conclusion

DCS' many years experience in EDI ensures your conversion will occur smoothly. The components (EDI system, ERP module, AS2 utility, and distributor requirements) can be orchestrated more harmoniously with expertise at hand. DCS' implementation, planning and development experience with EDI and ERP systems means our support and training is thorough, quick, and economical.

Since you need to be self-reliant and cost conscious, doing EDI with an expert that wants to help you improve your skills makes sense. Our DCS Process™ ensures your improvements will be done thoroughly and quickly. The next step is easy, email DCS for your Free Assessment.

For more in depth information:

• How to Reduce/Eliminate Chargebacks
• Read about prescription “Pedigree” Changes Needed

Return to top

Healthcare Providers and HIPAA Compliance

HIPAA EDI is too often erroneously considered a technical hurdle. Instead, it should be considered an opportunity to improve your data processes. Your successful integration will provide process automation to speed payment, enable your staff to focus upon other challenges, and cap head count. We can help you integrate with other organizations using your existing practice management system.

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.

Document exchange is a significant portion of the HIPAA challenge and a highly technical activity. Implementing the appropriate EDI and AS2 applications for your organization 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. (Working with the firewall administrator is required)
• 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 11g^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 business application and reporting themselves after DCS sets up programs to load the tables. Working jointly processes are swift and reliable.

Conclusion

Since integration is not trivial, we recommend DCS Grow^TM development service. DCS' many years experience in EDI across the nation is the foundation for DCS Grow^TM development service. 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.

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.

Return to top

Pharmaceutical Providers

Overview

Process management must occur quickly, easily, and without mistake. Process automation improvements that drive towards these goals while ensuring check points and exception reports are effective. Since product data can flow reliably from large customers, improved and automated procedures are necessary. For example, expired product data should readily download into your ERP system instead of arriving as a spreadsheet. This helps eliminate tedious and error prone manual entry and Reduce/Eliminate Chargebacks. This illustrates the forgotten fundamental of process automation: do it as small tasks so learning occurs that prepares for the next task.

The goal of EDI and Electronic Commerce is process automation. The best way is to use your existing systems to speed processes and reduce errors.

Another effective use of EDI is to automate Accounts Payables.

Conclusion

Creation of sound procedures will eliminate chargebacks and calls from irate, key customers. This task must be done properly, to minimize the project cost. DCS knows the challenges of AmerisourceBergen, Cardinal Health, and McKesson due to our experience with Rx ASNs, chargebacks, and order flow. On-going improvements are also easier when DCS is there to assist as needed. Our DCS Process™ ensures your evolution will be thorough and quick. Your next step is to email us for your Free Assessment.

For more in depth information:

• Read about prescription “Pedigree” Changes Needed
• DCS helps a client satisfy e-Pedigree ASN Requirements
• How to Reduce/Eliminate Chargebacks
• A pharmaceutical manufacturer needed to integrate EDI for 50 customers to their new SAP system

Return to top