THE HIPAA quiz: questions you should ask your vendors about compliance.If you are thinking about changing claims management vendors or clearinghouses, you might want to evaluate prospective candidates in light of the new HIPAA (Health Insurance Portability & Accountability Act of 1996, Public Law 104-191) Also known as the "Kennedy-Kassebaum Act," this U.S. law protects employees' health insurance coverage when they change or lose their jobs (Title I) and provides standards for patient health, regulations. The following questions will help you make a more informed choice among potential vendors. Questions a provider should ask a claims management application vendor * What is the name and title of your HIPAA compliance officer? * Is your HIPAA "compliant" version presently in production? * Can you provide a HIPAA gap analysis, remediation, and testing schedule and cost? * Will your system allow direct transmission to payers, or will the services of a clearinghouse be required? If a clearinghouse needs to be involved, can it be a clearinghouse of my choosing or is there a contractual/technical relationship between the vendor and a specific clearinghouse? * Does your application gather all data elements (required or situational)? * Can data be outputted in HIPAA-required format and content? * Does your application provide the elements found in the provider => payer 1 => provider => payer 2 model? * Does your system provide a print image of the transaction? If the system provides a print image file output, how do you propose I remediate re·me·di·a·tion n. The act or process of correcting a fault or deficiency: remediation of a learning disability. re·me the data gaps from the paper claim to the 837? Is there a checklist telling me what data will be missing? * What backups are there for component failure? * Is security an up-front design consideration, and if so, is a report of security requirements and controls available to validate To prove something to be sound or logical. Also to certify conformance to a standard. Contrast with "verify," which means to prove something to be correct. For example, data entry validity checking determines whether the data make sense (numbers fall within a range, numeric data application security? * Does your system provide features to prevent or alert system users to unauthorized browsing? Questions a provider should ask a payer * Is there a companion guide or are "business edits" in place for transaction processing Updating the appropriate database records as soon as a transaction (order, payment, etc.) is entered into the computer. It may also imply that confirmations are sent at the same time. Transaction processing systems are the backbone of an organization because they update constantly. ? * How are payments to providers handled? (Electronic Remittance Money sent from one individual to another in the form of cash, check, or some other manner. Financial statements sent by a creditor to a debtor frequently refer to the process of submitting a monthly remittance. REMITTANCE, comm. law. Advice/Electronic Funds Transfer) * Do you have samples of specifications, agreements, and other documents that a provider must follow? * Is there a testing schedule? What are the testing protocols? * What processes are required to switch from NSF NSF - National Science Foundation to ANSI (American National Standards Institute, New York, www.ansi.org) A membership organization founded in 1918 that coordinates the development of U.S. voluntary national standards in both the private and public sectors. It is the U.S. member body to ISO and IEC. ? * Do you require the use of a clearinghouse for transactions? * How long does it take to process claims and provide payment? * Do you provide DDE (Dynamic Data Exchange) A message protocol in Windows that allows application programs to request and exchange data between them automatically. DDE - Dynamic Data Exchange capabilities? If so, for what transactions? * Is security an up-front design consideration? Is a report of security requirements and controls available to validate security? * Do you support a provider => payer 1 => payer 2 => provider model? * What is your electronic payer ID? Questions a provider should ask a clearinghouse * What is the cost per transaction? * Can claim status and eligibility transactions be conducted in real time? * What are all the services that you offer? * What transactions do you support? * How much information will be returned on certain transactions? * Do you recommend, or are you working with, any claims management application vendors? * Have you adjusted your systems to reflect the companion guides or "business edits" of the payers? * Are you able to certify cer·ti·fy v. cer·ti·fied, cer·ti·fy·ing, cer·ti·fies v.tr. 1. a. To confirm formally as true, accurate, or genuine. b. that you can send compliant transactions? * Do you provide DDE capabilities? If so, for what transactions? * Do you presently have business agreements with the payers that I use? If not, what do you do with those claims if those payers are in my electronic file? * Do you support the provider => payer 1 => payer 2 => provider model? * Is security an up-front design consideration, and if so, is a report of security requirements and controls available to validate security? * Is there a testing schedule? What are the testing protocols? How long does testing usually take? * Is there a separate communications package I will need to transmit to you? * Is there a minimum configuration required in order to transmit to you? * Do you have a contingency plan A plan involving suitable backups, immediate actions and longer term measures for responding to computer emergencies such as attacks or accidental disasters. Contingency plans are part of business resumption planning. with all my payers? This information was provided by Beryl beryl (bĕr`ĭl), mineral, a silicate of beryllium and aluminum, Be3Al2Si6O18, extremely hard, occurring in hexagonal crystals that may be of enormous size and are usually white, yellow, green, blue, B. Fletcher, director of professional affairs for the Oregon Dental Association. |
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