HIPAA

[RMeyer]

I would like to know if anyone on this forum is from a healthcare environment and/or has any HIPAA Savvy. In particular I'm looking for information regarding mapping a print image UB92 to an ASC X12N Healthcare claim (837I). Any feedback on this subject would be greatly appreciated.

Ron

 

[GEFEG]

look at this link

http://www.mhccm.org/Pages/Toolkit/Map60.pdf

Good luck

GEFEG

 

[jalby]

We are currently working on this. I am not the developer however, do you have any specific questions or an email to contact you at. I know we had run into a couple of issues based of the vendor changes.

 

[ryebread]

A print image UB92 is insufficient to meet the needs of the 837I data requirements. You would have to data fill the additional required data fields with static (or deduced) values. This might not work if your receiver requires certain data not provided in the UB.

The WPC published 837I specs have sections that map fields from the UB92 and the EMC EDI format to the 837.

Best of Luck!
Ryan

 

[ryebread]

If any of you use the HIPAA Accelerator, what is your opinion of the product?

 

[RMeyer]

Thanks for all the feedback. Rye you are correct, the UB92 does not fulfill all the requirements of the new 837I. To overcome this we have added a "sidecar" to the UB92 which contains the additional data elements. We have the HIPAA Accelerator, but I have not put it to use yet. I have almost completed the initial development of an application that parses the print image of the UB92 and creates a file that I will then send to BizTalk and the HIPAA accelerator.

 

[jalby]

I am not sure what billing system you are using, we are on McKesson STAR Billing. They have an additional extract program to get the data needed dropped into a directory on the unix box.

Some issues we have encounterd deal with the parsing of the data as it is proprietery and could change, conflicting with the doc specs created for biztalk.

You asked about BizTalk documentation. I have found BizTalk Server developers guide published by McGraw Hill, and authored by Peishu Li, to be a pretty good source of info.

 

[jalby]

Do both you and Rye work for a hospital? if so are there other uses you are looking at biztalk for?

Some other thoughts in dealing with HIPAA, and I apologize if I am off topic as I don't do any of the mapping's or source spec's (dying to learn though)

If all the data is in the adt wich needs to flow to the billings system, than instead of using the print has the below listed approaches been looked at and would they be viable.

1. Don't use the print image, use the extract program to get the data than map it out.

2. If all the data needed comes from the adt to the billing system, and HL7 is the standard. Would it be possible to use the HL7 adapter with the HIPPA accelerator to map the data appropriately?

Again I apologize if I am throwing out things that should be obvious, I am just new to the biztalk world.

 

[ryebread]

I work for a HIS company who also provides EDI applications for direct claim submission.

The "sidecar" approach seems to be the most common solution that I've heard about. Jalby is right, the only issue is that its not standardized; each hospital or clearing house system solution is different, which makes this solution costly.

I guess the responsibility lies with clearing houses to accomodate every custom format they can to survive. Unless they are as large as WebMD/Envoy who have the economies of scale that allows them to require a certain input (NSF+ or an actual 837).

I really do not know anything about the HL7 adapter, but knowing Biztalk I do not think you can combine the two solutions unless your HL7 file contains every data element necessary to create your HIPAA transaction.

To combine adt info into your billing system I would consider using an sql database along with the sql adapter to place both data inputs into a common database then have biztalk map data into your hipaa format from the sql adapter. I would think that this is too much for a hospital it department to create and maintain.

I think the key is to communicate with both vendors to find a solution. If this is an issue then your hospital can't be the first one who needs this solution.

 

[HIPAA]

Hi Friends,

Yes,we are using BizTalk Acclerator for HIPAA 2.0 for mapping and WPC OnlyConnect Gap Analysis Tool To find out Gaps.

WPC FirstStep tool in testing.

Let me know anybady is working in this environment..

Thank's
Nar-

 

[ryebread]

According to Microsoft you can use the WPC OnlyConnect GAT to generate your Biztalk mapping files.

https://www.microsoft.com/solutions/hipaa/partners/firststep.asp

I am really interested in how well the mapping feature works in the Only Connect Gap tool. Do you use it for that purpose?

 

[HIPAA]

Yes We are using WPC OnlyConnect GAT...Know i got a chance to work with Microsoft.

It takes one more week for us to complete gap report..

I also very interested in this job...because..once we develop Gap reports in WPC OnlyConnect GAT.

It will automaticaly gives us Biztalk Suporting Maps...

My job is very easy then...

Let us see..how it works out.

Nar-
MICROSOFT/CGEY