Mastering HIPAA EDI Implementation Guides

Day One of One:

Session One: Introduction to Health Care EDI
This session introduces the basic concepts, components and definitions of EDI and its usage within the health care industry. The session identifies the benefits of implementation, and the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Session Two: Introduction to ASC X12 Standards
This session introduces the basic syntax on ASC X12 standards. The discussion then focuses on how the ASC X12 standards form the basis of the Health Care Implementation guidelines. The discussion focuses on examples of EDI documentation utilized by the health care industry.
Session Three: Getting Ready for Mapping
This session helps develop an understanding of the logic process required to master Healthcare EDI implementation. This session steps attendee through a comprehensive example using the (837) health care industry professional claim.
Session Four: Continuation of 837 Claim Exercise
This session completes the example that was started during Session Three.
Session Five: ASC X12 Envelopes
This session identifies the detailed content of the EDI envelopes, which are currently in use. It identifies how these envelopes are used in different EDI environments. It also stresses how the envelopes assist the EDI user address audit and control requirements. It includes an exercise in which the participants create an envelope consistent with the claim exercise. The topic will be presented on Day One. The exercise will be completed at the beginning of Day Two.

Day Two of Two:

Session One: Envelope Exercise
This session will utilize the 837 claim exercise and the envelope instruction developed on Day One as the basis of an example of the various layers of ASC X12 envelopes.
Session Two: ASC X12 Acknowledgments
This session provides a detailed description of the documentation of the functional acknowledgment and the interchange acknowledgment. Several examples of each are discussed. The session also provides discussion of how the acknowledgment provides a valuable audit tool.
Session Three: Introduction to Financial EDI
The concepts and definitions used in financial EDI are reviewed, and distinguished from electronic funds transfer. The concept of PATH is stressed in this session. Several examples of PATH variations are discussed. This discussion concludes with a discussion of the barriers to implementation of financial EDI.
Session Four: Remittance Advice for Health Care
This session is a working session. Attendees are lead through an exercise using Health Care Implementation Guidelines, to develop the structure of the 835 transaction set.
Session Five: Advanced Health Care EDI Topics
This session will covers three advanced topics on Health Care EDI. First we will discuss how to request changes or enhancements to the HIPAA implementation guides. Second we will review the Electronic Healthcare Network Accreditation Commission’s (EHNAC) Standard Transaction Format Compliance System, which you can use to test your transaction to see if they are compliant with the HIPAA implementation guides. Lastly we will discuss technologies you can use to secure your transmissions over the Internet.