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HIPAA 4010A1 to 5010 Migration:Rapid Compliance with a Step Up/Step Down Approach<br />
About Perficient<br />View a Recording of this Webinar and others at Perficient.com/Webinars<br />Perficient is a leading ...
PRFT Profile<br />Founded in 1997<br />Public, NASDAQ: PRFT<br />2009 Revenue of $188 million<br />18 major market locatio...
Our Solutions Expertise & Services<br />Business-Driven Solutions<br />Enterprise Portals<br />SOA and Business Process Ma...
IT Strategic Consulting
IT Architecture Planning
Business Process & Workflow Consulting
Usability and UI Consulting
Custom Application Development
Offshore Development
Package Selection, Implementation and Integration
Architecture & Application Migrations
Education</li></ul>Perficient brings deep solutions expertise and offers a complete set of flexible services to help clien...
Our Speaker<br />Martin Sizemore<br />Enterprise Architect with specialized skills in Enterprise Application Integration (...
Today’s Agenda<br />Define challenges facing organizations with a 4010A1 to 5010 Migration<br />Examine Choices for a Solu...
Recommended Tasks and Timelines<br />5010 Final Compliance<br />L2<br />Strategy and Assessment<br />Design & Build<br />I...
Solution Choices<br />Providing  options for 5010 Compliance<br />1<br />2<br />3<br />While each option has pros and cons...
Our Solution<br />Subject Matter Expertise<br /><ul><li>Business processes
  HL7 transactions
  Trading partners</li></ul>Toolset to automate 5010 processing <br /><ul><li>Reduces manual effort
Reduces testing effort
Improves speed to implement</li></ul>Tailored Approach<br /><ul><li>Assessment of current state, gap analysis
4010, 5010 parallel processing
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HIPAA 4010 a1 to 5010 migration

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HIPAA 4010 a1 to 5010 migration

  1. 1. HIPAA 4010A1 to 5010 Migration:Rapid Compliance with a Step Up/Step Down Approach<br />
  2. 2. About Perficient<br />View a Recording of this Webinar and others at Perficient.com/Webinars<br />Perficient is a leading information technology consulting firm serving clients throughout North America. <br />We help clients implement business-driven technology solutions that integrate business processes, improve worker productivity, increase customer loyalty and create a more agile enterprise to better respond to new business opportunities. <br />
  3. 3. PRFT Profile<br />Founded in 1997<br />Public, NASDAQ: PRFT<br />2009 Revenue of $188 million<br />18 major market locations throughout North America<br /><ul><li>Austin, Chicago, Cincinnati, Cleveland, Columbus, Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis, Minneapolis, New Orleans, Philadelphia, San Francisco, San Jose, St. Louis and Toronto</li></ul>1,400+ colleagues<br />Dedicated solution practices<br />~450 enterpriseclients (2009) and 85% repeat business rate <br />Alliance partnerships with major technology vendors<br />Multiple vendor/industry technology and growth awards<br />
  4. 4. Our Solutions Expertise & Services<br />Business-Driven Solutions<br />Enterprise Portals<br />SOA and Business Process Management<br />Business Intelligence<br />User-Centered Custom Applications<br />CRM Solutions<br />Enterprise Performance Management<br />Customer Self-Service<br />eCommerce & Product Information Management<br />Enterprise Content Management<br />Industry-Specific Solutions<br />Mobile Technology<br />Security Assessments<br />Perficient Services<br /><ul><li>End-to-End Solution Delivery
  5. 5. IT Strategic Consulting
  6. 6. IT Architecture Planning
  7. 7. Business Process & Workflow Consulting
  8. 8. Usability and UI Consulting
  9. 9. Custom Application Development
  10. 10. Offshore Development
  11. 11. Package Selection, Implementation and Integration
  12. 12. Architecture & Application Migrations
  13. 13. Education</li></ul>Perficient brings deep solutions expertise and offers a complete set of flexible services to help clients implement business-driven IT solutions<br />
  14. 14. Our Speaker<br />Martin Sizemore<br />Enterprise Architect with specialized skills in Enterprise Application Integration (EAI) and Service Oriented Architecture (SOA). <br />Martin has been a consultant and trusted advisor to CEOs, COOs, CIOs and senior managers for global multi-national companies and healthcare organizations.<br />His deep industry experience as a consultant in manufacturing, healthcare and financial services industries has provided him with a broad knowledge of IBM hardware and software offerings with numerous certifications and recognitions from IBM including On-Demand Computing and SOA Advisor. <br />He is experienced with Microsoft general software products and architecture, including SharePoint and SQL Server and has worked closely with Microsoft architects on healthcare products including their healthcare CRM, Amalga, and HealthVault offerings. <br />
  15. 15. Today’s Agenda<br />Define challenges facing organizations with a 4010A1 to 5010 Migration<br />Examine Choices for a Solution<br />Review the Edifecs Step Up/Step Down Solution<br />How this approach addresses the challenges<br />Pros and Cons <br />Next Steps<br />
  16. 16. Recommended Tasks and Timelines<br />5010 Final Compliance<br />L2<br />Strategy and Assessment<br />Design & Build<br />Internal Testing<br />External Testing<br />Conversion (Dual-Mode)<br />Training and Outreach<br />12/31/2010<br />01/01/2012<br />12/31/2011<br /> ICD-10<br />Compliance<br />10/01/2013<br />Program Management<br />We are here<br />L1<br /><ul><li>The timelines depicted above are illustrative only. The size of the organization and the level of impact would determine more realistic timelines</li></li></ul><li>Challenges<br />Regulatory deadline pressures<br />Competing with large IT projects<br />EMR implementations, claims processing modernization<br />Lack of experienced professionals with EDI X12 experience<br />Having 4010A1 and new 5010 transactions match for billing and A/R<br />Audit risk from government agencies<br />Waiting on software application vendors for ICD-10 upgrades<br />Many delayed until 2012 <br />Will need extensive testing<br />
  17. 17. Solution Choices<br />Providing options for 5010 Compliance<br />1<br />2<br />3<br />While each option has pros and cons, many organizations are exploring Step-Up/Step-Down solutions to mitigate risk.<br />
  18. 18. Our Solution<br />Subject Matter Expertise<br /><ul><li>Business processes
  19. 19. HL7 transactions
  20. 20. Trading partners</li></ul>Toolset to automate 5010 processing <br /><ul><li>Reduces manual effort
  21. 21. Reduces testing effort
  22. 22. Improves speed to implement</li></ul>Tailored Approach<br /><ul><li>Assessment of current state, gap analysis
  23. 23. 4010, 5010 parallel processing
  24. 24. Best practices</li></li></ul><li>Perficient’s Edifecs Partnership<br />Edifecs5010™ Step-Up/Step-Down Solution<br />Simple Translation Capabilities<br />Enterprise Capabilities<br />Edifecs5010™ Testing Solution<br />Edifecs SpecBuilder<br />Edifecs Ramp Management<br />Edifecs Transaction Management<br />Edifecs5010™ Compliance Online<br />Edifecs Trained Consulting Services from Perficient<br />World-class service professionals who are deeply conversant with HIPAA 5010 and trained in the latest technologies.<br />
  25. 25. Achieving HIPAA Compliance<br />Requirements<br /><ul><li>Accept inbound 5010 transactions and convert to 4010A1
  26. 26. Transaction Enrichment
  27. 27. Full validation required for transactions
  28. 28. View all transactions for ongoing visibility and auditing needs
  29. 29. Dual-use capabilities (accept both 4010A1 and 5010 transactions)
  30. 30. Trading partner management capabilities</li></ul>Standard<br />Version<br />Solution Components<br /><ul><li>Pre-built 4010A1-5010 maps
  31. 31. Edifecs SpecBuilder
  32. 32. Edifecs XEngine Translator
  33. 33. Edifecs Transaction Management
  34. 34. Edifecs Trading Partner Management
  35. 35. Consulting Services</li></ul>Solution Components<br /><ul><li>Pre-built 4010A1-5010 maps
  36. 36. Edifecs SpecBuilder
  37. 37. Edifecs XEngine Translator
  38. 38. Consulting Services</li></ul>Translation<br />Requirements<br /><ul><li>No need to validate transactions
  39. 39. Need short-term solution for processing both 4010A1 and 5010 transactions</li></ul>Foundation<br />Version<br />
  40. 40. Testing Challenges<br />Testing will account for 70% of HIPAA 5010 implementation costs (Gartner)<br />Building test data represents a significant portion of overall testing costs<br />Manual tasks to create and maintain test data drive up costs and decrease efficiency<br />Hours By Phase of Testing<br />Source: Edifecs Customer<br />
  41. 41. HIPAA Compliance Testing Solution<br />5010 Level 2 Testing (External)<br />Requirements<br /><ul><li>Trading Partner Management
  42. 42. External Transaction Testing
  43. 43. Complete front-end testing
  44. 44. Migration Dashboard/Reporting
  45. 45. Test linking inbound and outbound transactions</li></ul>Solution Components<br /><ul><li>SpecBuilder
  46. 46. Publish Guidelines
  47. 47. XEngine
  48. 48. Validation
  49. 49. Ramp Management
  50. 50. Easily onboard and test with Trading Partners
  51. 51. Transaction Management
  52. 52. Maintain Visibility
  53. 53. Manage Trading Partners</li></ul>5010 Level 1 Testing (Internal)<br />Requirements<br /><ul><li>Convert 4010A1 test files to 5010
  54. 54. Test companion guides
  55. 55. Test SNIP edits
  56. 56. Test acknowledgment generation
  57. 57. Test file splitting
  58. 58. Test Data creation and management</li></ul>Solution Components<br /><ul><li>SpecBuilder
  59. 59. Create and Test Guide Lines
  60. 60. Analyze Results
  61. 61. XEngine
  62. 62. Validation
  63. 63. Test Management
  64. 64. Create and manage test data
  65. 65. Ramp Management
  66. 66. Test files</li></li></ul><li>Case Study: External Testing<br />28% of survey respondents have over 500 Trading Partners to onboard<br />Total trading partner onboarding time reduced from 17+ hours to 35 minutes<br />
  67. 67. Business Process Flow<br />837 Process<br />4010 Claims batch from Stanford & Mayo combined<br />Adjudication System A<br />(accepts 4010 only)<br />4010 batch for Sys A and Sys B<br />Clearinghouse<br />Stanford Hospital<br />Validation<br />Translation<br />Batching Routing<br />Web / FTP<br />Adjudication System B<br />(accepts 5010 only)<br />Mayo Clinic<br />5010 batch for Sys A and Sys B<br />5010 Claims batch from Stanford & Mayo combined<br />835 Process<br />System A (Generates 4010 Remittance Advice)<br />4010 Remittance batch for Stanford & Mayo<br />4010 batch of Remit Advices<br />Stanford Hospital <br />Clearinghouse<br />Splitting Routing<br />Translation<br />Validation<br />Web / FTP<br />Mayo Clinic<br />System B<br />(Generates 5010 Remittance Advice)<br />5010 Remittance batch for Stanford & Mayo<br />5010 batch of Remit Advices<br /><ul><li>Lossless Translation
  68. 68. End-to-end view of transaction flow</li></li></ul><li>Use Case Scenario<br />Patient Account Representative (PAR) inquires about missing Claim Payment<br />Highlighted Benefits of the Step-Up/Step-Down Solution<br />Ability to Search and Filter across all incoming and outgoing transactions exchanged with trading partners<br />Validation of 4010A1 and 5010 transactions and Lossless Translation between both standards (Pre-Built Maps)<br />Batching and appropriate routing<br />Steps for resolving the PAR’s problem<br />Check if we really did receive the claim<br />Review the entire path of the claim through various processing events i.e. through validation, translation and routing to the right adjudication system<br />Find the payment generated by the adjudication system as a response to our claim<br />Provide details to the PAR so they can follow up with the clearinghouse<br />
  69. 69. Architectural View of a Step-Up/Step-Down Implementation<br />Major Advantages: Speed, no “Rip and Replace” of existing systems and parallel testing of 4010A1 and 5010 transactions to assure proper billing and A/R<br />
  70. 70. Added Value from the Perficient Approach<br />Leverage our healthcare analytics knowledge to develop add-ons to the Edifecs5010™ Solution to provide assurance to for 4010A1 to 5010 Migration.<br />Key example: Edifecs Healthcare Transaction Repository (HTR) is a consolidated repository of 100% of the 4010A1 and 5010 transactions stored in a business-normalized schema.<br /><ul><li>Perficient can develop analytical reports to compare the 4010A1 and 5010 transactions each day, week or month to assure the Chief Financial Officer that revenue and billing are under control
  71. 71. Perficient can develop reports to analyze transactions by trading partner to balance transmissions inbound and outbound to the organization
  72. 72. Perficient can develop reports to support the testing and quality assurance effort and re-use them for multiple clients
  73. 73. Perficient can manage the performance testing of 5010 solutions</li></li></ul><li>Solution Evaluation<br />Pros<br />Rapid deployment for “late starters”<br />Allows a phased approach to remediation on your schedule<br />Defers total cost of 5010 remediation into more managed phases<br />Edifecs has integration capabilities beyond 4010 to 5010 migration<br />HL7 Interoperability, XML<br />Cons<br />Still not an “easy” solution – requires planning, implementation and testing<br />Typically the solution requires EDI subject matter expertise<br />Professional services may be needed to speed implementation to meet deadlines<br />Small amount of “back end” systems remediation is needed<br />
  74. 74. Next Steps<br />What are the biggest risks to your 5010 implementation right now?<br />Were there any areas of the problem space or solution that the Edifecs solution does not address?<br />When do you plan on starting with external testing?<br />Q&A<br />
  75. 75. Follow Perficient Online<br />Perficient.com/SocialMedia<br />Daily unique content about content management, user experience, portals and other enterprise information technology solutions across a variety of industries.<br />Twitter.com/Perficient<br />Facebook.com/Perficient<br />
  76. 76. Thank You!<br />

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