Re the real-time conduct of the paired 270/271 and 276/277 transactions it’s probably worthwhile for folks here to know about the CAQH/CORE operating rules. (all the information about CAQH and CORE can be found at www.caqh.org)
Essentially, the CORE operating rules have and are being developed in a consensus-based process by health industry-wide collaboration of more than 100 multi-type stakeholders (providers, health plans, clearinghouses, vendors). The CORE operating rules require that the eligibility and claim status request/response transactions be conducted in real-time with 20 seconds or less response time (total round trip). There are other operating rules that address other “infrastructure” and data content requirements. Infrastructure addresses not only real time requirements, but also system availability, the use of the X12 TA1 and 997 acknowledgements for both real time and batch. The CORE Phase I and some of the Phase II operating rules have been incorporated into the HITSP interoperability specifications (www.hitsp.org) Phase III of CORE operating rule developing will be launched in early 2009. Industry adoption of the CORE operating rules is proceeding at an increasing pace – see the 12/30/08 press release inserted below. And regardless of whether one assumes that all of these transactions are “classic” batch information exchanges, there is really nothing in them that precludes them from being conducted in real time. CAQH PRESS RELEASE ORGANIZATIONS SUPPORT CAQH INITIATIVE TO IMPROVE PATIENT ADMINISTRATIVE DATA ACCESS Washington, D.C. (December 30, 2008) − The American Academy of Family Physicians (AAFP); Gateway EDI; MD On-Line, Inc.; mPay Gateway, Inc.; RealMed Corp.; Secure EDI Health Group, LLC; and Summit Medical Group have stepped up their commitment to improving provider and hospital access to consistent electronic patient administrative data through the CAQH Committee on Operating Rules for Information Exchange <http://rs6.net/tn.jsp?e=001dWtXIdbPJKdSFtG1IyaEC2QjOe1GCiWhMwRSk4P2yMcyf77OcCsFGPAnwpWp5He8bp4Eoq9z1qKeVV4L2_ijxb7VufW8UaxoyYcyQYPtlnuUKucPH425Ug==> (CORE) initiative. A nonprofit alliance of health plans and trade associations, CAQH launched CORE to create an all-payer solution that enables provider access to patient insurance information before or at the time of service using the electronic system of their choice. The organization has brought together more than 100 industry stakeholders to collaborate on a multi-phase set of uniform business rules to achieve that goal. MD On-Line, Inc.; RealMed Corp.; and Summit Medical Group have completed a testing process to certify their systems or product meet CORE Phase I <http://rs6.net/tn.jsp?e=001dWtXIdbPJKcEs7GQJ0eH5qdSV9laG9bx_Uz95iY9LJtzzZID3JUhBWjiO0fll5APUme7hCJM5G80V0l3t5QtreToOYiASpNyZpNb4rtjQ0GegwmAlBHPaeyiJENCB3Nh> rules requirements. MD On-Line, a clearinghouse processing in excess of 2 million electronic transactions per month, certified its ACCE$$ - Patient Eligibility Verification product. RealMed, a healthcare revenue cycle management services vendor serving approximately 22,000 physicians and health care professionals representing nearly 900 distinct medical groups including physician practices, academic medical centers, national laboratories and medical billing services certified its RealMed Revenue Cycle Management internet based product. Summit Medical Group, which includes 200 physicians in 50 office locations and 10 hospitals serving patients in nine Tennessee counties, was certified as a large provider group. These three organizations join more than 30 other entities, including health plans covering approximately 65 million or one-third of U.S. commercially insured lives, that are certified as operating in compliance with the <http://rs6.net/tn.jsp?e=001dWtXIdbPJKfG5r6I1TDegeN3G1mXaeFG7XEkdel_jLlc2AcHUK4JtbXM1QVlb6cmKYrKDB9da-S9a01gKcf0KCvVju-hkprxAQxKcHuVv4ZI26JEx0M1hmaAsLbrljoG> CORE Phase I rules. Built upon national standards, including HIPAA, CORE rules make electronic administrative data communications seamless, streamlined and predictable, regardless of the technology – in many cases eliminating the need for time-consuming phone calls and paperwork. In anticipation of the industry moving from HIPAA Version 4010 to Version 5010, CORE Phase I and Phase II rules incorporate many of the features found in the X12 5010 TR3s to address the common information needs for patient eligibility. Gateway EDI; mPay Gateway, Inc.; and Secure EDI Health Group, LLC; all health IT vendors, joined CORE to participate in developing additional phases of the CORE rules. AAFP received CORE Phase II rules Endorser status this past summer. CORE participants have begun the process to develop Phase III rules, which will focus on improving the electronic exchange of additional administrative transactions, such as prior authorization and remittance advice. About CAQH CAQH is a catalyst for healthcare industry collaboration on initiatives that simplify and streamline healthcare administration. CAQH solutions help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration, facilitate administrative healthcare information exchange and encourage administrative and clinical data integration. Visit <http://rs6.net/tn.jsp?e=001dWtXIdbPJKfdWsDcsIzsw-t0d-7_aRijoeSLrd0zUPUnEbZ-nkfYLLyxtOPOkCIV31QMV0xqn8zYbm8y0FHHt5bo1G63Qv4YKYByHXk-bM4=> www.caqh.org for more information. Rachel Foerster Senior CAQH/CORE Consultant Boundary Information Group Rachel Foerster & Associates Ltd. 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 www.rfa-edi.com RFA Ltd Framed New Logo From: [email protected] [mailto:[email protected]] On Behalf Of Michael Mattias/LS Sent: Wednesday, December 31, 2008 10:23 AM To: EDI-L Subject: Re: [EDI-L] Any realtime issues when implementing 270, 271, 276, 277, 834, 835, 820 12/31/08 > Please help me with above messages, if anyone who worked on it, had > face some challenges or issues that they want to share. "Issues" and "challenges" is kind of vague, isn't it? First of all, the only documents above where you should even be 'thinking' about 'realtime' are the 270/271 pair; all the others are essentially 'classic' batch-type business transactions. Second, I have found the ANSI EDI portion of "handling" the 270/271 document pair far less challenging than getting the ERP system (or humans) to provide the information required to fully support the 271 response. AFAIK, most payers send the 271 with only the "covered Yes/No" info and few provide the pricing (allowed, copays , deductibles, etc) info. Michael C. Mattias Tal Systems Inc. Racine WI [email protected] <mailto:mmattias%40talsystems.com> [Non-text portions of this message have been removed] ------------------------------------ ... Please use the following Message Identifiers as your subject prefix: <SALES>, <JOBS>, <LIST>, <TECH>, <MISC>, <EVENT>, <OFF-TOPIC> Job postings are welcome, but for job postings or requests for work: <JOBS> IS REQUIRED in the subject line as a prefix.Yahoo! Groups Links <*> To visit your group on the web, go to: http://groups.yahoo.com/group/EDI-L/ <*> Your email settings: Individual Email | Traditional <*> To change settings online go to: http://groups.yahoo.com/group/EDI-L/join (Yahoo! ID required) <*> To change settings via email: mailto:[email protected] mailto:[email protected] <*> To unsubscribe from this group, send an email to: [email protected] <*> Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
