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Health Ecommerce, Hipaa Transactions 2003

  • ID: 29578
  • HIPAA-IT LLC
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Health Ecommerce, Hipaa Transactions 2003
Updated : 2003
Audience: professionals with financial, technical, or operational responsibilities, particularly implementing transactions.

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1 HIPAA 1<BR>1.1 INTRODUCTION 2<BR>1.2 HEALTH INDUSTRY TRENDS 3<BR>1.3 HISTORY 4<BR>1.3.1 Bush ’89-‘93 5<BR>1.3.2 Clinton ’93-‘01 5<BR>1.3.3 Schedule 6<BR>1.4 STANDARDS REQUIRED 7<BR>1.5 APPLICABILITY 8<BR>1.5.1 Covered Entities 8<BR>1.5.2 Media 9<BR>1.6 COMPLIANCE ACT 10<BR>1.7 SUMMARY 11<BR>2 FINANCE 13<BR>2.1 ECOMMERCE FOR SMALL PROVIDER 14<BR>2.2 WORKFLOW 15<BR>2.2.1 Example at RWJUH 15<BR>2.2.2 Eligibility (270/271) 17<BR>2.2.3 Authorization (278) 18<BR>2.2.4 Billing (837) 19<BR>2.2.5 Claims Inquiry (276/277) 20<BR>2.2.6 Remittance Advice (835) 21<BR>2.2.7 Financial Impact 21<BR>2.3 ONE VERSUS MANY 22<BR>2.4 COST/BENEFIT 26<BR>2.4.1 Software Costs 27<BR>2.4.2 Savings 29<BR>2.5 THIRD-PARTY VENDORS 29<BR>2.6 QUALITATIVE IMPACTS 32<BR>2.7 SUMMARY 33<BR>3 STANDARDS AND TRANSACTIONS 34<BR>3.1 STANDARDS 34<BR>3.2 STANDARDS ORGANIZATIONS 36<BR>3.3 STANDARDS DEVELOPMENT 38<BR>3.4 CLAIMS HISTORY 38<BR>3.5 EDI HISTORY 41<BR>3.6 X12 ADMINISTRATION 42<BR>3.7 X12 TECHNICAL DETAILS 42<BR>3.8 ELIGIBILITY EXAMPLE 44<BR>3.9 SUMMARY 47<BR>4 CODES AND IDENTIFIERS 48<BR>4.1 CODES 48<BR>4.1.1 Conceptual Models 49<BR>4.1.2 Diseases 50<BR>4.1.3 Drug Code Usability 51<BR>4.1.4 Metadata 56<BR>4.1.5 Ambiguity and Future 57<BR>4.2 IDENTIFIERS 57<BR>4.2.1 Provider Identifiers 57<BR>4.2.2 Employer Identifier 64<BR>4.2.3 Personal Identifier 65<BR>4.2.4 Routing 66<BR>4.3 SUMMARY 67<BR>5 TRANSLATORS 68<BR>5.1 GAP ANALYSIS 68<BR>5.2 TRANSLATOR 71<BR>5.2.1 Mercator 72<BR>5.2.2 Sybase 73<BR>5.2.3 Microsoft 76<BR>5.2.4 Other Vendors 77<BR>5.3 TESTING 78<BR>5.3.1 Levels 78<BR>5.3.2 Marketplace 79<BR>5.3.3 Example 79<BR>5.4 CERTIFICATION 81<BR>5.4.1 Accreditation 81<BR>5.4.2 Who? 82<BR>5.5 SUMMARY 83<BR>6 IMPLEMENT 84<BR>6.1 PLAN 84<BR>6.2 CONNECTIVITY OPTIONS 85<BR>6.3 SPREADSHEET 87<BR>6.4 CHOOSING A TRANSLATOR 91<BR>6.5 SEQUENCING 93<BR>6.6 TRADING AGREEMENT 94<BR>6.7 SUMMARY 96<BR>7 CASE STUDIES 97<BR>7.1 SMALL PROVIDER 97<BR>7.2 MID-SIZED NETWORKS 98<BR>7.2.1 John Muir/Mt Diablo 99<BR>7.2.2 Others 100<BR>7.3 HEALTH INSURERS 102<BR>7.3.1 MEGA Life and Health 102<BR>7.3.2 Blue Shield of California 104<BR>7.4 MEDICAID 104<BR>7.5 DEPARTMENT OF DEFENSE 107<BR>7.5.1 Approach 107<BR>7.5.2 Data Elements 108<BR>7.5.3 Provider Perspective 108<BR>7.5.4 Health Plan Perspective 110<BR>7.6 CLEARINGHOUSES 112<BR>7.7 EMPLOYERS 114<BR>7.8 SUMMARY 115<BR>8 COMMUNITIES 117<BR>8.1 COMMUNITY HEALTH NETWORKS 117<BR>8.2 HEALTH ECOMMERCE NETWORKS 118<BR>8.3 ORGANIZED CARE 120<BR>8.4 SUPPLY CHAIN MANAGEMENT 122<BR>8.5 CONSUMERS 123<BR>8.5.1 Web Trends 123<BR>8.5.2 Examples 125<BR>8.5.3 Email 126<BR>9 CONCLUSION 128<BR>9.1 EDI AND IMPACT 128<BR>9.2 CODES AND TOOLS 129<BR>9.3 IMPLEMENT AND CASES 130<BR>10 APPENDIX 133<BR>10.1 THE LAW 133<BR>10.2 TRANSACTION RULE 136<BR>10.2.1 General Requirements 136<BR>10.2.2 Administrative Requirements 139<BR>11 REFERENCES 149<BR>12 INDEX OF TERMS 155<BR>

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