Hi Rachel-
You are correct that we are not the only game in town when it comes to transaction validation. Of course this list is not the appropriate place to discuss all the capabilities of our solutions and how they perform/compare against our competition. Suffice it to say that some of the largest clearinghouses in the country use our solutions to perform the "run time" validation you discuss below. We refer to those edits as "production" validation but validating transactions in the production stream doesn't necessarily relieve a trading partner of the requirement to test.
A clearinghouse can spend many millions of dollars each year enabling trading partners and a big part of that is spent hand-holding clients through the testing and implementation process. Trading partners usually move from test to production after they prove the capability to meet production requirements. It's not often that a trading partner begins exchanging transactions in a full production mode. This happens only when the partner's own system has deep validation edits and the clearinghouse, through repeated testing with multiple system users, sees few errors. Most trading partners, before they can get transactions into production, must test to be certain they meet the clearinghouse requirements (which include the requirements of the destination payers).
I think there's some misunderstanding as to the Community Enablement model and how it relates to testing and implementation. It's a new concept though so I'd like to take a moment to further explain how this might work for a clearinghouse, the example that you've given.
Testing and implementation are part of the over enablement process. Under the Community Enablement model, trading partners can join the community and begin testing against the requirements of all their destination payers at once. They could test against a single destination payer's requirements. They could test HIPAA compliant transactions up to type 7 (8, 9, etc.). If they wanted to they could use the community to test for HIPAA compliance in general (types 1 - 6) while they're still working internally to prepare for a standard exchange this is a great value add on the part of the clearinghouse since it can save their trading partners the cost of a third party tool). They could test non-standard transactions like an extended NSF or some proprietary format. The testing is self-service so it doesn't drain the resources of the clearinghouse. A trading partner can test one or one hundred times, doesn't matter. When they run into problems the community resources and members support the client in their trouble-shooting efforts.
These resources could include very specific instructions (even with illustrations) from the vendor, who is also a member of the community, on precisely what they need to do to correct a problem. Lots of providers don't even know how to build a claim file using their own system so resources could include very basic information like that. Resources might also include information from the payer (who is also a member of the community) on what they mean by a particular requirement. Enablement is ongoing. Trading partners need ongoing support to resolve issues that come up in production so when a clearinghouse uses the Community Enablement model the community assists the client to resolve errors they find in validation edits occurring at "run-time".
Rachel, we'll be at the HIPAA Summit in DC next week so if you'd like to stop by and learn more, please do. It would be nice to catch up.
Marcallee Jackson
Director, Healthcare Solutions
Edifecs, Inc.
Office 562-438-6613
Cell: 714-865-5059
-----Original Message-----
From: Rachel Foerster [mailto:[EMAIL PROTECTED]]
Sent: Friday, March 21, 2003 7:45 PM
To: WEDI SNIP Testing Subworkgroup List
Subject: RE: EDIFECS Trading Partner Enablement
While the EDIFECS tool may be "fabulous" as you assert, it is most certainly not the only game in town by which providers can have their claims transactions content validated at run time against a payer's companion documents. I am aware of at least one major healthcare clearinghouse/transaction processor that offers this capability now to all of the providers coming through its network for the major payers across the country.
What this means is that the providers do not have to worry about testing in some type of community enablement effort, but can begin sending their HIPAA claims to their major payers comfortable with the knowledge that their claim content will be validated against that payer's companion documents each and every time they transmit a claim to that payer.
Rachel
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