Statement of HIPAA Readiness February 2003

Transcription

1 Statement of HIPAA Readiness February 2003 Copyright 2003 WebMD Envoy Corporation. All Rights Reserved. Rev. 02/03

2 Table of Contents 1 Meeting the HIPAA Challenge...1 Overview...1 WebMD Envoy HIPAA Readiness...2 HIPAA Standard Transactions Translation...3 Overview...3 WebMD Envoy Products...4 Health Plan Connections...4 Electronic Remittance and Other Administrative Transactions Privacy and Security...5 Overview...5 i

3 1 Meeting the HIPAA Challenge Overview WebMD Envoy is the leader in providing comprehensive EDI connectivity and information exchange solutions to the healthcare industry. We connect and provide supporting services to more than 300,000 physicians, 46,000 pharmacies, 4,600 hospitals, 1100 health plans, and 600 vendor partners. Coupling our two decades of experience with our unequaled breadth of service offerings, no other company is better situated to help you meet the challenges and take advantage of the significant opportunities presented by the Health Insurance Portability and Accountability Act (HIPAA). At WebMD Envoy, we've upgraded our technology infrastructure, realigned resources, and worked in tandem with industry leaders to establish standards and best practices with respect to HIPAA. We have already established compliant connectivity with many of our largest partners and are currently processing more compliant transactions than any other company. Over the last year, we've been working hard to expand our connectivity offering. WebMD Envoy is now able to provide comprehensive Medicare, Medicaid, and Blue Cross/Blue Shield connectivity in addition to the extensive commercial connectivity WebMD Envoy has been known for. Beyond claims, HIPAA opens a world of opportunity. By October 2003, HIPAA will promote the widespread adoption of a powerful array of electronic transactions including electronic remittance, eligibility verification, referral authorization and claims status transactions that span the full breadth of the patient's encounter with the provider. The addition of these new transaction types will yield dramatic benefits in improved cash flow and administrative efficiency. Many WebMD Envoy clients are already taking advantage of these transaction types. Our "All Payer/All Transaction" solution provides, for the first time, a single point of connectivity between providers and health plans. WebMD Envoy, as your single point of connectivity, can process all electronic transactions, provide comprehensive reporting, and help you maintain compliance with the evolving HIPAA landscape. 1

4 WebMD Envoy HIPAA Readiness WebMD Envoy has long believed that the adoption of EDI standards will improve efficiencies in the health care system and WebMD Envoy representatives have served on the committees that developed HIPAA transactions standards. Because of our depth of knowledge and our commitment to HIPAA standards, WebMD Envoy fully appreciates and can help our customers manage to the complex and ever-changing HIPAA transactions standards. HIPAA Standard Transactions The HIPAA transactions and code set regulations require that the following transactions be conducted according to defined standards after October 15, 2003: HIPAA Standard Format ASC X12N 837 v4010 ASC X12N 837 v4010 ASC X12N 837 v4010 ASC X12N 835 v4010 ASC X12N 270/271 v4010 ASC X12N 276/277 v4010 ASC X12N 278 v4010 NCPDP v5.1 Transaction Health Care Claim: Professional Health Care Claim: Dental Health Care Claim: Institutional Health Care Claim Payment/Advice Health Care Eligibility/Benefit Inquiry and Information Response Health Care Claim Status Request and Response Health Care Services Review - Request for Review and Response Pharmacy Claim All WebMD Envoy service offerings within the required categories support HIPAAstandard transactions. WebMD Envoy currently supports Professional, Dental, and Institutional Health Care Claims using the ASC X12N 837 version 4010 standard. For Pharmacy claims, WebMD Envoy currently supports the NCPDP version 5.1 standard. WebMD Envoy can accurately process a claim sent to it by submitters in these formats (in either its May 2000 "Final" Version or in its pending "Addenda" version) and can forward that claim accurately to any health plan accepting claims in that format. In order to facilitate the transition to this HIPAA standard and in response to customer requests, WebMD Envoy is editing these transactions in accordance with requirements defined by our health plan partners. In Spring 2003, WebMD Envoy will implement, for those customers who submit claims directly, a guidance reporting process that will analyze each customer's claims and identify the data required to adhere to the HIPAA regulations. WebMD Envoy will assist our customers in making informed decisions about the steps they must take to adhere to the required data content. WebMD Envoy has published Companion Documents setting forth its particular implementation of transactions using the HIPAA-standard formats. Copies of these documents are available online at 2

5 2 Translation Overview from Legacy Claims Formats to HIPAA-Standard Formats Currently, most providers send claims to WebMD Envoy in a variety of non-hipaastandard legacy formats. Of these, the most commonly used formats are WebMD Envoy's implementation of the National Standard Format (NSF) and the MCDS format used by WebMD Envoy for claims intended for commercial health plans. A number of additional legacy formats (such as HCDS and DCDS) are also in use. WebMD Envoy is translating information sent to it in these legacy formats into the format of the HIPAA-standard transactions. However, whether WebMD Envoy can create a HIPAA-standard transaction from the information sent to it in these legacy formats will depend on whether the legacy format submission includes all of the data elements required in the ASC X12N standard for that provider and type of claim. In general, the HIPAA standard includes some data elements not found in the NSF formats and many data elements not found in the MCDS formats. However, many of these elements are required only in certain types of HIPAA-standard claim transactions. Whether an individual claim submitted to WebMD Envoy in a legacy format contains all the data elements necessary to create a HIPAA-standard transaction for that particular claim will vary by provider and by type of claim. WebMD Envoy has created a dedicated HIPAA Transition and Implementation team to work with vendors of Physician Office Management Information Systems (POMIS) and Hospital Information Systems (HIS), as well as with large submitters to determine to what extent their claims will require data elements not found in their legacy format(s) to create a HIPAA-standard transaction. Some vendors and submitters may require only minimal changes. Many vendors and submitters may extend their systems to use the NSF Plus version 2.01, MCDS Plus, DCDS Plus, or HCDS Plus formats. Copies of the limitations for each of these formats and requests for these specifications are available online at Providers who use the enhanced NSF, MCDS, DCDS, and HCDS formats will be able to send sufficient data to WebMD Envoy for WebMD Envoy to create HIPAA-complaint transactions for most claims types. However, a small number of claim types will require the submitter to use the ASC X12N formats or to use an alternative submission effort (such as WebMD Office or WebMD Internet Claims Submission). Based on the types of claims submitted by each provider, the WebMD Envoy HIPAA Transition and Implementation Team will provide guidance to the applicable software vendor or provider submitter. 3

6 WebMD Envoy will assist vendors and providers with determining their own best strategy for sending WebMD Envoy the necessary data. The WebMD Envoy HIPAA Transition and Implementation Team will be assisting submitters and health plans with this effort as they work through the process of reaching their HIPAA compliance goals. WebMD Envoy Products Some customers currently send claims to WebMD Envoy using point-of-sale (POS) terminals and software provided by WebMD Envoy. WebMD Envoy has created updated versions of these products with the HIPAA data requirements in mind; WebMD Office and AccuClaim Plus will send all of the data necessary for WebMD Envoy to create HIPAA-standard transactions. Older versions of WebMD Envoy products may not send sufficient data for WebMD Envoy to create a HIPAA-standard transaction, depending in part upon the type of transaction being performed. WebMD Envoy will be providing users of these legacy products with further information about the HIPAA compatibility of the products they currently use and detailed instructions about upgrading your system. Health Plan Connections As of February 2003, WebMD Envoy has over 50 large health plans in production using a HIPAA-standard Professional Claim format and is actively testing with another 100 health plans. Claims sent to WebMD Envoy from submitter customers in legacy formats are, today, being converted into this HIPAA-standard format and forwarded to these payers. WebMD Envoy is leading the clearinghouse industry in establishing these HIPAA-standard connections with its health plan payer customers. Electronic Remittance and Other Administrative Transactions WebMD Envoy can currently receive and process transactions for Electronic Remittance Advice and the following real-time transactions (Eligibility, Claims Status, and Referrals) in the applicable HIPAA-standard formats: Transaction Electronic Remittance Advice Referral Eligibility Claim Status HIPAA-Standard Format ASC X12N 835 v4010 ASC X12N 278 v4010 ASC X12N 270/271 v4010 ASC X12N 276/277 v4010 4

7 3 Privacy and Security Overview WebMD Envoy takes data privacy seriously. We have a long history or protecting the privacy and security of patient and other data, and we enthusiastically support the HIPAA privacy standards. These regulations, which come into effect April 14, 2003, will require all Covered Entities (providers, clearinghouses, and health plans) to comply with a detailed regulatory framework limiting the use and access of certain patient information. WebMD Envoy is implementing the HIPAA Privacy regulations through a coordinated corporate effort to identify all uses of protected information, reinforce and develop policies to protect that information, and to train all affected WebMD Envoy employees on their obligations under HIPAA. As part of its privacy compliance, WebMD Envoy will provide its customers who send its protected information with the required written assurances (a "Business Associate" agreement) that WebMD Envoy will maintain the privacy of information sent to it. In addition, WebMD Envoy uses advanced security technologies to protect the information it processes from intrusion. As part of its privacy compliance effort, WebMD Envoy is implementing security "best practices" in advance of the pending final HIPAA Security regulations. 5