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HIPAA Compliance Solutions
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Author
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Steve Bass, Lisa Miller, and Bryan Nylin
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Pages
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176
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Disk
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N/A
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Level
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All Levels
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Published
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11/28/2001
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ISBN
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9780735614963
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Price
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$39.99
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Index
A
Accelerator. See BizTalk Accelerator for HIPAA
ADA (American Dental Association), claim form and procedure standardization, 16
A. D. Little, study on use of EDI in grocery industry, 5
administration, BizTalk Server, 59
Administrative Simplification
HIPAA and, 32
Web site, 2
agencies (public), as funding source for health care, 78-79
AHA (American Hospital Association), billing form standardization, 9
AMA (American Medical Association)
requests to delay HIPAA by, 29
role in standardization of health insurance claim form, 15
American Dental Association (ADA), claim form and procedure standardization, 16
American Hospital Association (AHA), billing form standardization, 9
American Medical Association (AMA)
requests to delay HIPAA by, 29
role in standardization of health insurance claim form, 15
American National Standards Institute (ANSI)
Standards Development Organizations (SDOs), 10
X12 standard for Electronic Data Interchange, 6
American Public Human Services Association (APHSA), requests to delay HIPAA by, 29
ANSI (American National Standards Institute)
Standards Development Organizations (SDOs), 10
X12 standard for Electronic Data Interchange, 6
APHSA (American Public Human Services Association), requests to delay HIPAA by, 29
B
Bass, Earl J. ("Buddy"), 5, 7
Bass, Steve, 5, 6
BCBSA (Blue Cross Blue Shield Association), requests to delay HIPAA by, 29
Benefit Enrollment and Maintenance-834, X12N HIPAA Implementation Guide Schemas, 61-62
Benefit Information (EB) segments, 63
benefits, Eligibility, Coverage or Benefit Information-271, 63-64
best practices concept, 21
billing forms, standardization of, 9-10
BizTalk Accelerator for HIPAA
components of, 60-61
as core technology in HIPAA Solution, 36
envisioning potential benefits from, 74
Healthaxis case study, 45
as solution for HIPAA compliance, 55
using in tandem with BizTalk Server 2000, 56
BizTalk Document Tracking, 59
BizTalk Editor, 56-57
BizTalk Mapper, 57-58
BizTalk Messaging Manager, 59
BizTalk Orchestration Designer, 58
BizTalk Server 2000
components, BizTalk Document Tracking, 59
components, BizTalk Editor, 56-57
components, BizTalk Mapper, 57-58
components, BizTalk Messaging Manager, 59
components, BizTalk Orchestration Designer, 58
components, BizTalk Server Administration, 59
as core technology in HIPAA Solution, 36
using in tandem with BizTalk Accelerator for HIPAA, 56
BizTalk Server Administration, 59
Blue Cross Blue Shield Association (BCBSA), requests to delay HIPAA by, 29
Braithwaite, William R., 1
BUSAP (Business Applications), as basis of X12 standard, 6
Bush, President George H. W., 12, 13
Business Applications (BUSAP), as basis of X12 standard, 6
business functions, HIPAA compliance and, 62
C
capitation model of health care, 75
Carley, Joseph, 5, 7
claims
Electronic Remittance Advice (ERA), 67-68
Health Care Claim Transaction (837), 64
requesting current status of, 66-67
standardization of forms, 15-16
clients, HIPAA Solution, 37
clinical trials, 78
Clinton, President William J., 13-14
CMS/HCFA Common Procedure Coding System (HCPCS), 15
Code on Dental Procedures and Nomenclature, 16
compliance, HIPAA
business functions and, 62
mandatory and best practice considerations, 21-23
OnlyConnect Methodology and, 43
solution for, 55
consulting services, offered by Microsoft and WPC, 37
consumers, health
benefits of HIPAA for, 77
consumer-enabled technology, 81
core technologies, HIPAA Solution, 36
Current Components, Inc., 26-27
D
Data Interchange Standards Association (DISA), as X12 secretariat, 7
data standardization, NCVHS's role in, 8-9
Dental Electronic Content Committee (DeCC), claim form and procedure standardization, 16
Department of Health and Human Services (DHHS), on costs of implementing HIPAA, 31
dependents
defined, 64
as participant in enrollment process, 62
deployment phase. See also technical deployment
Healthaxis case study, 53
HIPAA Solution, 41
Designated Standards Maintenance Organization (DSMO), 17-19
address to concerns about HIPAA, 31
guiding principles of, 18
organizations designated by HIPAA as DSMOs, 17
recommendation process to NCVHS, 18-19
design goals, Healthaxis case study, 49
destination payer, 64
development phase
Healthaxis case study, 51-53
HIPAA Solution, 40-41
device manufacturers, benefits of HIPAA for, 78
DHHS (Department of Health and Human Services), on costs of implementing HIPAA, 31
DISA (Data Interchange Standards Association), as X12 secretariat, 7
document tracking, 59
DSMO. See Designated Standards Maintenance Organization (DSMO)
E
EB segments, 63
E-codes (injury codes), role of NCVHS in development of, 8
Ed Guilbert Professional Award, 7
EDI (Electronic Data Interchange)
business value of, 25-27
Colonel Ed Guilbert's role in founding, 4-5
overview of, 1
in petroleum industry, 28
publication of standards of, 6-7
using in grocery industry, 5
X12 standard for, 6
EDI (Electronic Data Interchange), in health care industry, 7-19
American Dental Association and Dental Electronics Content Committee, 16
American Hospital Association and National Uniform Billing Committee, 9-10
American Medical Association and National Uniform Claim Committee, 15-16
business value of, 27
Designated Standards Maintenance Organization (DSMO), 17-19
Health Level Seven, 11-12
National Committee on Vital and Health Statistics, 7-9
National Council for Prescription Drug Programs, 10-11
Workgroup for Electronic Data Interchange, 12-14
X12N (insurance subcommittee), 14-15
editors, BizTalk Editor, 56-57
EFT (Electronic Funds Transfer), 62
Electronic Data Interchange. See EDI (Electronic Data Interchange)
Electronic Funds Transfer (EFT), 62
Electronic Media Claims (EMC), 10
Electronic Remittance Advice (ERA), 67-68
Eligibility, Coverage or Benefit Information-271, 63-64
Eligibility Request Document Specification, BizTalk Editor, 56-57
eligibility requests, 63, 64
EMC (Electronic Media Claims), 10
employers
as domain of health care industry, 75
private sector funding for health care, 78-79
enrollment process, participants in, 61-62
envisioning phase
Healthaxis case study, 45-47
HIPAA Solution, 39
ERA (Electronic Remittance Advice), 67-68
Extensible Stylesheet Language (XSL), 57
F
Failure Mode Effects and Analysis (FMEA) tool, 47
Federal Register, publication of EDI standards in, 22
FirstPass, OnlyConnect, 71-72
FMEA (Failure Mode Effects and Analysis) tool, 47
G
Gap Analysis, 42
Gap Analysis Tool (GAT), 68-70
connect frame of, 69-70
implementation guide frame of, 68
OnlyConnect Framework and, 42
grocery industry, using EDI in, 5
Guilbert, Colonel Ed, 4-5, 7
H
HCPCS (CMS/HCFA Common Procedure Coding System), 15
Health and Human Services (HHS), 12-13
Healthaxis, HIPAA Solution case study, 44
health care
envisioning changes in, 73-75
as secondary to profit motive, 75
vision for new economy for, 79
health care administration, turbulence vs. streamlined approaches, 27
Health Care Claim Payment/Advice-835, 67-68
Health Care Claim: Professional, Institutional, and Dental, 64-65
Health Care Claim Status Request-276, 66-67
Health Care Claim Status Response-277, 67
Health Care Claim Transaction-837, 64
Health Care Eligibility Request-270, 63
Health Care Reform Task Force, 13-14
Health Care Services Review: Request for Review-278, 65-66
Health Insurance Portability and Accountability Act of 1996 (HIPAA). See also HIPAA Solution
consequences of violations, 2-3
countdown to implementation, 2
electronic interchange for, 1
"Final Rule on Standards for Electronic Health Care Transactions," 2
HIPAA phobia, 29-30
potential benefits from, 73
relationship of transaction provisions within whole of HIPAA, 3-4
Health Insurance Portability and Accountability Act of 1996 (HIPAA), implementing, 21-34
business value of EDI and, 25-29
cost of, 31-33
mandatory and best practice considerations, 20-24
requests for delays, 29-31
value of, 33-34
Health Insurance Reform: Standards for Electronic Transactions, 22
Health Level Seven (HL7), standards for interoperability, 11-12
health maintenance organizations (HMOs), capitation model and, 75
health plans, HIPAA compliance and, 21-23
HHS (Health and Human Services), 12-13
HIPAA Implementation Guide Schemas. See X12N HIPAA Implementation Guide Schemas
HIPAA parser, of BizTalk Accelerator, 60
HIPAA Solution, 35-53. See also Health Insurance Portability and Accountability Act of 1996 (HIPAA)
components of, 55
consulting and training services offered by Microsoft and WPC, 37
core technologies, 36
deployment phase, 41
development phase, 40-41
envisioning phase, 39
OnlyConnect Framework, methodology of, 41- 42
OnlyConnect Framework, steps in, 42-43
partnership model, 37
planning phase, 39-40
role of Microsoft and Washington Publishing Company in, 35
specialized technologies, 36-37
HIPAA Solution, case study, 44-53
deployment phase, 53
development phase, 51-53
envisioning phase, 45-47
planning phase, 48-51
project review, 53
project timeline, 44
HL7 (Health Level Seven), standards for interoperability, 11-12
HMOs (health maintenance organizations), capitation model and, 75
I
ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification), 15
Implementation Architecture, OnlyConnect Methodology, 43
implementation team, Healthaxis case study, 49
Independent Software Vendors (ISVs), HIPAA partners, 37
information, integration of capture and management, 80
injury codes (E-codes), role of NCVHS in development of, 8
insured/members, as participant in enrollment process, 62
insurers, as participant in enrollment process, 61
International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), 15
ISVs (Independent Software Vendors), HIPAA partners, 37
K
Kennedy-Kassebaum (K2) bill, 2
L
long-term care, 65
M
manufacturers
device manufacturers, benefits of HIPAA for, 78
as domain of health care industry, 74
Mapper. See BizTalk Mapper
Martin, Kendra, 28
MCS (Microsoft Consulting Services), 37
medical code sets, mandated by HIPAA, 15
Medical Group Management Association (MGMA), opposition to delays in administering HIPAA, 30
medical innovation, 78
medical service providers, Health Care Eligibility Request-270 and, 63
Messaging Manager, BizTalk, 59
MGMA (Medical Group Management Association), opposition to delays in administering HIPAA, 30
Microsoft BizTalk. See BizTalk Server 2000
Microsoft Consulting Services (MCS), 37
Microsoft, role in HIPAA Solution, 35
Microsoft SQL Server 2000
as core technology, 36
used by BizTalk Server 2000, 56
Microsoft Windows 2000 Server, as core technology, 36
Miller, Chris, 26
N
National Committee on Vital and Health Statistics (NCVHS), 7-9
DSMO recommendations to, 18
relationship of NUBC to, 10
role in data standardization, 8-9
role in HIPAA, 9
National Council for Prescription Drug Programs (NCPDP), 10-11
National Standard Format (NSF), 56
National Uniform Billing Committee (NUBC), 9- 10
National Uniform Claim Committee (NUCC), 15-16
NCPDP (National Council for Prescription Drug Programs), 10-11
NCVHS. See National Committee on Vital and Health Statistics (NCVHS)
Notice of Proposed Rule Making (NPRM), 12
Notto, Ralph, 5, 7
NPRM (Notice of Proposed Rule Making), 12
NSF (National Standard Format), 56
NUBC (National Uniform Billing Committee), 9- 10
NUCC (National Uniform Claim Committee), 15-16
O
OC. See OnlyConnect Framework (OC Framework)
OnlyConnect Framework (OC Framework)
combining OnlyConnect Methodology (WPC) with Solution Framework (Microsoft), 38- 39
deployment phase, 41
development phase, 40-41
envisioning phase, 39
methodology, 41-42
phases overview, 38-39
planning phase, 39-40
steps in, 42-43
OnlyConnect Methodology
FirstPass, 56, 71-72
Gap Analysis Tool (GAT), 56, 68-70
overview of, 41
steps in, 42-43
Orchestration Designer, BizTalk, 58
Orchestration, OnlyConnect Methodology, 43
P
partnership model, HIPAA Solution, 37
patient events, 65-66
patients, 64-65
payers
benefits of HIPAA for, 33-34, 77
destination payer, 64
as domain of health care industry, 74
as participant in enrollment process, 61
secondary payers, 65
Payment Order/Remittance Advice-820, 62
pharmacies, standards for electronic transmission of retail pharmacy information, 10-11
physicians, benefits of HIPAA for, 76
planning phase
Healthaxis case study, 48-51
HIPAA Solution, 39-40
prescription drugs, standards for electronic transmission of retail pharmacy information, 10-11
privacy rules, in HIPAA, 3-4
private sector employers, as funding source for health care, 78-79
profit motive, health care and, 76
project structure document, Healthaxis case study, 47
project timeline, HIPAA Solution case study, 44
providers
benefits of HIPAA for, 34, 75-76
defined, 65
as domain of health care industry, 74
service providers, 66
public sector agencies, as funding source for health care, 78-79
purchase orders, X12, 6
R
R&D (research and development), benefits of HIPAA for, 78
red tape, decreasing, 21
Regulated Transactions (RTs), X12 Standard Implementation Guides, 24-25
Remittance Advice, 62
requesters, 66
request for eligibility transaction set, 77
Request for Review-278, 65
research and development (R&D), benefits of HIPAA for, 78
risk assessment, Healthaxis case study, 47
RTs (Regulated Transactions), X12 Standard Implementation Guides, 24-25
S
SDOs (Standards Development Organizations)
address to concerns about HIPAA, 31
ANSI, 10
secondary payers, 65
service providers, defined, 66
SGML (Standard Generalized Markup Language), 6
SIs (System Integrators), HIPAA partners, 37
smart devices, 80
Social Security Act, consequences of violations of HIPAA, 2-3
Solution. See HIPAA Solution
solution design document, Healthaxis case study, 50
specialized technologies, HIPAA Solution, 36-37
sponsors, as participant in enrollment process, 61
SQL Server 2000
as core technology, 36
used by BizTalk Server 2000, 56
Standard Generalized Markup Language (SGML), 6
Standards Development Organizations (SDOs)
address to concerns about HIPAA, 31
ANSI, 10
State Uniform Billing Committees (SUBCs), state counterparts of NUBC, 10
style sheets, used by BizTalk Mapper, 57
SUBCs (State Uniform Billing Committees), state counterparts of NUBC, 10
subscribers
defined, 65
as participant in enrollment process, 62
Sullivan, Dr. Louis, 12-13
System Integrators (SIs), HIPAA partners, 37
T
TAGs (Technical Advisory Groups), WEDI, 14
tax burden, for health care, 79
TDCC. See Transportation Data Coordinating Committee (TDCC)
Technical Advisory Groups (TAGs), WEDI, 14
technical deployment, BizTalk Server 2000 components, 56-61
BizTalk Document Tracking, 59
BizTalk Editor, 56-57
BizTalk Mapper, 57-58
BizTalk Messaging Manager, 59
BizTalk Orchestration Designer, 58
BizTalk Server Administration, 59-61
OnlyConnect FirstPass, 71-72
OnlyConnect Gap Analysis Tool, 68-70
technical deployment, X12N HIPAA Implementation Guide Schemas, 61-68
Benefit Enrollment and Maintenance-834, 61- 62
Eligibility, Coverage or Benefit Information-271, 63-64
Health Care Claim Payment/Advice-835, 67- 68
Health Care Claim: Professional, Institutional, and Dental-837, 64-65
Health Care Claim Status Request-276, 66-67
Health Care Claim Status Response-277, 67
Health Care Eligibility Request-270, 63
Health Care Services Review: Request for Review-278, 65-66
Payment Order/Remittance Advice-820, 62
technology
accessible, 80
adaptable, 81
consumer-enabling, 81
flexible, 80-81
technology validation, Healthaxis case study, 51- 52
testing, Healthaxis case study
pilot testing, 53
preproduction testing, 52-53
Third Party Administrators (TPAs), as participants in enrollment process, 62
TPAs (Third Party Administrators), as participants in enrollment process, 62
training services, offered by Microsoft and WPC, 37
transactions
defined, 24
NCVHS's role in standardizing, 9
provisions within whole of HIPAA, 3-4
testing, 43
X12N Identifiers, 24-25
transmission intermediaries, defined, 65
Transportation Data Coordinating Committee (TDCC)
BUSAP initiative of, 6
publication of EDI standards by, 5
role in development of UPC, 5
turbulence vs. streamlined health care administration, 27
U
UB (Uniform Billing) manual, 9-10
UCC (Uniform Code Council), early history of, 5
UCS (Uniform Communication Standards), 5
UMO (Utilization Management Organization), 66
Uniform Billing (UB) manual, 9-10
Uniform Code Council (UCC), early history of, 5
Uniform Communication Standards (UCS), 5
Uniform Hospital Abstract Minimum Data Set, 8
Uniform Product Code Council (UPCC), 5
United Parcel Service (UPS), implementation of EDI by, 26
Universal Product Code (UPC), development of, 5
UPCC (Uniform Product Code Council), 5
UPC (Universal Product Code), development of, 5
UPS (United Parcel Service), implementation of EDI by, 26
U.S. Department of Health and Human Services, Administration Simplification Web site, 2
Utilization Management Organization (UMO), 66
V
VICS (Voluntary Interindustry Commerce Standard), X12 Purchase Order, 6
violations, consequences of, 2-3
vision for fundamental change, 73-82
device manufacturers, 78
new health care economy, 79-81
new health care landscape, 74-75, 81-82
payers, 77
private and public funding, 78-79
providers, 75-76
technology empowering consumers, 73-74
vision statement, Healthaxis case study, 45
Voluntary Interindustry Commerce Standard (VICS), X12 Purchase Order, 6
W
Wal-Mart, implementation of EDI by, 26
Washington Publishing Company (WPC)
consulting and training services offered by, 37
publication of EDI standards by, 6-7
Web sites
Administration Simplification Web site, 2
DSMO, 19
implementation of HIPAA, 25
Uniform Code Council (UCC), 5
Voluntary Interindustry Commerce Standard (VICS) for, 6
WEDI. See Workgroup for Electronic Data Interchange (WEDI)
Windows 2000 Server, as core technology, 36
Workgroup for Electronic Data Interchange (WEDI), 12-14
applying EDI to health care, 12-13
recommendations of, 13-14
Technical Advisory Groups (TAGs) of, 14
WPC (Washington Publishing Company)
consulting and training services offered by, 37
publication of EDI standards by, 6-7
X
X12N HIPAA Implementation Guide Schemas, 61-68
Benefit Enrollment and Maintenance-834, 61- 62
Eligibility, Coverage or Benefit Information-271, 63-64
Health Care Claim Payment/Advice-835, 67- 68
Health Care Claim: Professional, Institutional, and Dental, 64-65
Health Care Claim Status Request-276, 66-67
Health Care Claim Status Response-277, 67
Health Care Eligibility Request-270, 63
Health Care Services Review: Request for Review-278, 65-66
Payment Order/Remittance Advice-820, 62
X12N (insurance subcommittee), 14-15
diverse membership of, 15
specialized insurance task groups of, 14
transaction set identifiers, 24-25
X12 standard
EDI approach of, 27-29
for EDI (Electronic Data Interchange), 6
XLANG schedules, 58
XSL (Extensible Stylesheet Language), 57
Last Updated: November 14, 2001
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