IAIABC EDI ProPay Subcommittee September 12, 2007 Lexie Chambers - Broadspire Leslie White – CS Stars Jeremiah Bentley – Texas Mutual Shawn Maloney - ROES Adrian Czajka - Consultant Michelle Mooneyham – MSC Kim Diehl – Fiserv Sandy Guidry - Ingenix Faith Howe - IAIABC Patrick Stack – Jopari Patrick updates on this morning’s ANSI issues call – refocus on exploring gap analysis things. Worked on Adrian’s document, where he will add a few issues that we will work on over the next few months – CA & TX gap issues. They are not standing in the way of implementation; need to analyze if our recommendations are different from the California & Texas recommendations. There might be some advice to those who would have to work around those issues. Impact document: is there a way to soften it? Maybe along with the issues document – let everyone see & comment. ANSI group created document that outlined deviations & their impact on trading partners who are trying to implement CA or TX may have done something that is outside of HIPAA that may have an impact on senders. This is to let users know that they can’t just pick up a standard HIPAA implementation guide; they have to work with & around the variances. – not to complain that CA & TX might have done something bad or derail the progress. Instead of making it public to general audience, give to jurisdiction to release to their stakeholders. Sensitive issue: MN trying to do an implementation of HIPAA – we would like them to reconsider & be more like TX & CA, but now we are also telling TX & CA that they have areas to work on. Shawn to work with others to see how they can tone down & then give to jurisdictions to present to trading partners. Patrick will also have handout (Adrian doing main issue list & Patrick is putting together issues from last meeting, along with CA & TX status.) Workflow group: created what we thought was being passed, but realized need more medical provider input. AHA will get their membership to give their input, who has asked for our documentation to distribute for comment – what have we left out, where are frustrations, where we can work together. Went out to George Arges yesterday. Expect feedback very soon. Also focusing on 270/271 process (eligibility in group health). MN is mandating usage with a HIPAA implementation, in 2009. This was a hot item for workflow anyway, but policy verification & eligibility will be a primary factor in workers' compensation to try to alleviate the problems. Shawn has invited POC to attend Thursday’s ProPay to discuss 270/271. NCCI has 17 states that allow providers to look up coverage at NCCI. Doesn’t help with non-NCCI state, but it’s a place to start. Is there another transaction out there? Can POC people come up with any options to get the coverage info? AHA input Get true policy experts in to give their thoughts Jurisdictions will develop their own e-bill implementations if this is not successful – we have to let them know that we are working on this so that we can minimize the number of separate state-specific requirements in use. Sheryl Minyard has been working with NUBC; identified gaps between what’s required from the EDI perspective & what’s on the paper form. Want NUBC to include workers' compensation data requirements on their forms. Has prepared a document we can review to see the status of the issues. Education – Sheryl’s brown bag got sidetracked to TX medical mandate- workers' compensation is entering e-bill arena. We need to do everything we can to help to publicize; jurisdictions need to do so, too. CA appears to be having same issues. (CA stakeholders seem to be using forums to complain they aren’t paid enough instead of paying attention to ProPay.) TX doing their educational session in about week & ½. But still not enough of the population is aware of what is going on and what they will be required to do. Michelle suggests contacting medical associations. Kim – how has TX medical association done any publicity? Will follow up with them to see what they have done. Patrick will check on CA. IAIABC to contact to try to develop seminar, educational association. Clearinghouses – who are they? Ehnac Kim GregHerzog@texmed.org 512-370-1360 was at first few stakeholder meetings & involved – how to coordinate the educational effort. Emdeon, P2P, ENS, Jopari –we need to get them to sit down with us & see how we can communicate with providers to get them on board with us. Sandy - Texas Health Information Network – billing for Medicare, Medicaid – would that be a good education source? She will send contact information to Shawn. Shawn will see about getting clearinghouses together for conference call – they are competitors, but still need to educate the providers. Come up with a plan & then figure out how to get the work done. Jeremiah - Mike Reed at Tx Med Assoc has contacts, too. Lexie: would Texas be willing to push their 1/1 date back? Leslie: asked Joseph & he said absolutely not. Allen McDonald is new contact. Process to request waiver is now on TX website. Spreadsheet of those who have been granted a waiver is supposed to be on the website. Shawn announced that we are working with a possible jurisdiction representative to lead the ProPay group. After the Phoenix meeting, our next call will be in October.
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