Attendees:
Brandi Wyatt - EDIFECS
Ed Hafner - Foresight
Miriam Paramore - PCI
Kerry - EPIC Systems
Lou Oliver - Advent Software
Patrick Edwards - Arkansas Blue Cross
Tim Collins - Kentucky Medicaid
Dave Frankel - EDIFEG
Suzan Ryder - Empire Blue Cross Blue Shield
John Lilleston - Verizon
Agenda Items:
1) Review of Washington D.C. Conference:
Ed Hafner reported that the Testing breakout session went very well.
There were over 100 people in the room for the session and over 40 surveys
were completed and returned to Ed after the session. Brandi also said she
overheard several positive comments about the session after it was over.
Many people liked that we were presenting actual testing experiences and
statistics but some felt that there was not enough time provided in the
session to allow the attendees to digest the information and ask questions.
2) Issue from Issues Database:
The following issue was assigned to the Testing SWG and was discussed
during the meeting -
Can a health plan require that an entity
certify with a third party testing service
in order for the entity to begin testing
with a plan. If so, can the health plan
require that certification be obtained from
a particular third party and if so, any
caveats to that? Along these same lines, can
a health plan require that an entity certify
against its companion guidelines, with a
third party testing service in order for the
entity to begin testing with a plan. If so,
can the health plan require that
certification be obtained from a particular
third party? Any caveats to these two items?
This issue created a lot of discussion. The HIPAA legislation or
ASCA does not mention certification or verification so the issue is pretty
much left up to the formation of a best practice. The group agreed that
requiring a third party validation/certification would need to be detailed
in a Trading Partner Agreement (TPA). If a health plan does require this
type of activity, they do have the right to require a particular third
party for this purpose because certain business level editing would also
probably be built into the software used by the third party that was
specific to that particular payer. Not all third party vendors would have
that specific editing functionality because they had not been working hand
in hand with that specific health plan. The bottom line is that validation
and/or certification is not required by the HIPAA legislation although it
is recommended by the WEDI Testing white papers. Any requirement that is
outside of the scope of the HIPAA legislation would need to be documented
and agreed upon in a Trading Partner agreement.
Please review the verbiage above as we would like to draft a final response
to this issue during the next meeting and enter it on the SNIP website.
4) Next Steps for Testing SWG:
Sue and John had discussed a couple of topics that the Testing SWG
may want to undertake as our next steps. One idea was to develop a white
paper as to business scenarios when the 997, TA1, 824, etc. transactions
would be used. Also, document the advantages and disadvantages of using
standard transactions versus proprietary ones until the standards are
mandated.
Brandi Wyatt also came up with another testing idea and will document that
idea to the group prior to the next meeting. We will devote an agenda item
to this subject for the next meeting and try to make some decisions as a
group.
Thanks!!
____________________________________________
John D. Lilleston
Section Manager - Healthcare EDI
Verizon Information Technologies, Inc.
Phone - (813)979-3225
Fax - (813)978-5570
[EMAIL PROTECTED]
www.VerizonIT.com
____________________________________________
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