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Regulatory Compliance

Were you ready for HIPAA 5010?

Hopefully everyone answered ‘yes’ and you had a smooth transition. In this blog we will discuss some of the items we need to keep in mind when either transitioning or implementing EDI.

Whether you are getting ready to transition to a new standard or initiating EDI for the first time, remember the most important thing is to KNOW YOUR DATA NEEDS!

Knowing what data you expect to send and receive is one of the most important items you can establish.

First, review the standard for the transaction set(s) you want to use (some of the transaction sets used for healthcare are 835, 834 837, 270/271, etc). Whether this is for Healthcare, Automotive, or any other standard, this is very important. This will give you an idea of what data is available and what you can plan to accommodate. Remember, just because it is in the standard does not mean you need that piece of data.

Once you have reviewed the standards, you need to get everyone involved: business users, a data mapper, a database administrator, trading partners and anyone else who might have a vested interest. It might surprise you as to what data they will actually need and utilize. Whether the data is used in the data warehouse or for reports it is important to identify your business needs. Also, try to plan for future business requirements. Just because you don’t use that piece of data right now doesn’t mean you might not need it as standards evolve. You can start with a “wish list” and pare it down from there. Keep in mind that just because you want to receive a particular piece of data, your translation software may not currently be set up to capture, your trading partner may not be able to accommodate, or your clearinghouse may not have that set up in their maps. We all would like to have everything, but it is not always practical.

If you are converting to a new standard this is the chance to change things. Just because it has always been done that way is no reason to continue – that may not be the best practice. This gives you a chance to make things better and perhaps correct things that were not working right before. If you are initiating a new transaction set, this is the perfect opportunity to grab the data you need and get everything set up right the first time. This is where it is important to get the users involved. As the person doing the research you may not think a piece of data is important, but to them it may be very necessary.

When you have identified all your data needs you are ready to move on to the next step – mapping the fields in the standards to your database. We will talk about that in our next blog.

Have you initiated EDI? What data issues did you face? How did you overcome them?

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Deborah O'Rear, Sr. Technical Consultant

Deborah O’Rear is a business-focused, outcomes-driven consultant with more than 15 years of healthcare industry experience. She has a vast depth of EDI and BSA knowledge to support healthcare clients. Deborah is well versed in articulating, clarifying, and writing business requirements, establishing implementation strategies, QA, user stories, and testing.

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