State Medicaid Systems (MMIS) are paid for by the feds and each state has 'standardized' on their own version of MMIS so there are 50+ of them i.e. every state has there own at taxpayer expense. For the most part changes to MMIS systems are the result of state or federal legislation not of a progressive healthcare organization.
David Frenkel ________________________________ From: Brian Lehrhoff <[email protected]> To: Michael Mattias/LS <[email protected]>; EDI-L <[email protected]> Sent: Tue, September 13, 2011 10:43:20 AM Subject: Re: [EDI-L] Presentation of Integration Best Practices We did those X12 formats in 1994 at Healthfirst, but they didn't want to pay for the van and State of New York could not take a tape of edi formatted data. We punted back to the fixed record formats and simply ran a tape once a month and sent it off via UPS. No rush. Brian Lehrhoff, EA ([email protected]) Messaging Consultant 201-913-4506 Upgrade your Quickbooks for 20% off at http://ea.brianlehrhoff.com Circular 230 Notice is located at http://ea.brianlehrhoff.com/230notice.html ________________________________ From: Michael Mattias/LS <[email protected]> To: EDI-L <[email protected]> Sent: Tuesday, September 13, 2011 8:53 AM Subject: Re: [EDI-L] Presentation of Integration Best Practices >Medicare used the paper HCFA forms and converted it to a flat electronic >file >which was not X12. WEDI developed X12 EDI before HIPAA but nobody used >it. Medicare had official X12 formats defined going back to at least 1993-1994. This I recall clearly because my first healthcare-industry client - a Medicare Part A Fiscal Intermediary - gave me the task of converting from the 003020-based Medicare standard (2A) to the 003030-based 3A, and then to the 0003051-based 4A standard. (FI's were required to support "current" and "[at least] one level back" X12 standards) HOWEVER... almost no one used those ANSI X12 formats, instead opting to use the National Standard Formats, which are (were?) in fact pretty much flat file images of the UB92 (facility) and HCFA-1500 (professional) paper claim forms. Medicare, too, had "current official" versions of NSF it accepted for electronic claims and returned for remittances. >Each state also had regulatory exceptions to 'EDI' that required paper for >some time. Absolutely. For tjhat matter, Medicare did too, e.g. for COB claims where Medicare was the secondary payer. Add to that... transactions with payers *other than Medicare* were 100 percent defined by those payers... and while often "close to" or "based on" the Medicare standards, each payer made his own rules... making it not very handy for providers. (In fairness, each payer also had "exceptions" to the NSF formats, too!) Michael C. Mattias Tal Systems Inc. Racine WI [email protected] David Frenkel ________________________________ From: Michael Mattias/LS <[email protected]> To: EDI-L <[email protected]> Sent: Fri, September 9, 2011 12:47:25 PM Subject: Re: [EDI-L] Presentation of Integration Best Practices > If the healthcare industry could have envisioned long term value in things > like >EDI there would not be the the government intervention we have now with >HIPAA. But you know, Medicare (your tax dollars at work) had enforced "electronic claims and payments ONLY" since the early or mid 1990's (First Part A; then Part B I think got fully converted only about 1999 or 2000).... so healthcare SHOULD have been aware if the long-term value in EDI WAAY before it was mandated. While the use of EDI as a PROACTIVE strategy has certainly been somewhat less than ubiquitous, there is that one retailer from tiny Bentonville AR who was certainly aware of the long term value of EDI.... and they have done, well, "OK" I guess..... .. and the Auto manufacturers... and the rest of the retailers... and... well, golly, maybe the word has gotten out after all! Michael C. Mattias Tal Systems Inc. Racine WI [email protected] [Non-text portions of this message have been removed] ------------------------------------ ... Please use the following Message Identifiers as your subject prefix: <SALES>, <JOBS>, <LIST>, <TECH>, <MISC>, <EVENT>, <OFF-TOPIC> Job postings are welcome, but for job postings or requests for work: <JOBS> IS REQUIRED in the subject line as a prefix.Yahoo! Groups Links ------------------------------------ ... 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