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Choosing your clearinghouse or VAN is a very important step, especially if you are in healthcare. In healthcare you need to make sure they are HIPAA compliant, which means they will be able to handle all the mandated transaction sets. Other industries have different requirements. Whichever clearinghouse you choose, you need to make sure they can handle all the transaction sets you might want to utilize.
When shopping for your clearinghouse or VAN, make a check list of your requirements. Here are a few of the most common questions you’ll want to address in creating your list:
What transaction sets can they handle? In healthcare, some of the transaction sets would be 834, 837, 835, 270/271, 276/277, etc.
- What is the problem resolution process? Who do you contact? How is the issue resolved? If there is a programming change how long does it take for the change to be effective?
- How is data transmitted? Is this done via web connection, SFTP, FTP, etc?
- How often is data transmitted? Is data transmitted real time, batch, once daily, etc?
- What is the cost per transaction set? Is the charge per ISA, transaction set, or bytes?
- What is the initial set up fee?
- What is the contract period?
- What additional expenses are required? Do you need additional hardware, software, programming, etc. to trade data with the clearinghouse?
It is a good idea to have at least 2 different proposals put together. Best case and acceptable scenarios, with justification for each. This will give management a good idea of why you are proposing a particular clearinghouse/VAN.
Once you have gathered all the information you can put together the proposed budget for this implementation.
Whether this is an implementation of its own or part of a larger implementation, keep in mind to get all affected parties involved. This will help eliminate issues further down the road.
Are there any additional questions you would consider for your requirements list?
Is it flexible? If your data needs to be changed, how easily changes can be made to the software will be critical.
Let’s begin with the layout of the transaction set for outbound data. I have found that the best way to start is to take the segments of the transaction set and put them in an Excel spreadsheet, keeping in mind to maintain the segment looping structures. Once you have the segments in your document you can then flesh them out further by putting in the individual data elements and sub-elements for that segment. As you are doing this it would be a good idea to mark each data element as to whether or not they are required, optional or situational. This will help you determine what needs to be present when creating the final product.