Business-to-business White Paper V2 subtopic 2 should be revised. After
clearinghouse software has been proven to successfully process a particular
line of business, provider-to-payer or payer-to-provider testing would still
be required in many instances, including the following:
1) when clearinghouse files come from "upstream" systems or go to
"downstream" systems and there's a new or significantly-changed map
associating the up- or downstream legacy files to the clearinghouse files
2) to confirm that the content of transactions is accurate from the business
perspective; for example
a) to confirm that, on a particular claim, the different providers
(billing, pay-to, rendering, referring, attending etc.) are properly passed
through the clearinghouse and into the target system of the trading partner;
where payors use referral data to analyze provider practice patterns, this
can become especially of concern...
b) to confirm that, for PPO claims, contracted disounts are not being
applied twice because of an error in the way billing data is picked up by
the clearinghouse
NOTE: a and b are only examples; what is important to test will vary based
on the character of each covered entity.
3) When HIPAA-ready legacy systems are newly installed and those systems
have required significant change, for example to accomodate
newly-standardized claim adjustment reason codes (Hopefully the legacy
system vendors will be open regarding the extent of changes to accommodate
HIPAA)
At least one of the above items 1, 2, and 3 applies for just about every
covered entity, right? So trading partner testing will be more of a rule
than an exception - it will require less manpower to test as more partners
are tested. But it'd be foolhardy for trading partners to not do any
trading partner-to-trading partner testing...
Cynthia Korman, Principal
Strategic System Solutions, LLC
973 394-9529
[EMAIL PROTECTED]
www.healthcare-systems.com
----- Original Message -----
> From: "Rishel,Wes" <[EMAIL PROTECTED]>
> To: <[EMAIL PROTECTED]>
> Sent: Tuesday, May 21, 2002 5:05 PM
> Subject: Full-loop vs Trading Partner Testing
>
>
> > My reading of subtopic 2 in the Business to Business Transaction Set
> Testing
> > Version 2 white paper is that there is no need for provider-to-payer
> testing
> > where a clearinghouse is involved provided that the clearinghouse is not
> > using modified software to handle the provider and has previously
> > demonstrated that it can handle the lines of business that will be
> proffered
> > by the provider.
> >
> > Is that a correct interpretation? Is it pretty much the consensus?
> >
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>
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