All,
Just a reminder that we have a Testing SWG conference call scheduled for
Thursday, June 5th at 11:30 a.m eastern time. The call in number is
703-736-7290 pc
1315339. The agenda will be as follows:
1) Roll Call
2) Issues Data Base New Issue Assigned to Testing SWG
The issue assigned to the group is:
Can a health plan require that an entity certify with a third party testing
service in order for the entity to begin testing with a plan. If so, can
the health plan
require that certification be obtained from a particular third party and if
so, any
caveats to that? Along these same lines, can a health plan require that an
entity certify against its companion guidelines, with a third party testing
service in order for the entity to begin testing with a plan. If so,can the
health plan require that
certification be obtained from a particular third party? Any caveats to
these two items?
The draft response we came up with at last meeting:
The HIPAA legislation or ASCA does not mention certification or
verification so the issue is basically left to the formation of a best
practice across the industry. Requiring a third party
validation/certification would need to be detailed in a Trading Partner
Agreement(TPA)along with who was responsible for the cost of this service
or software. If a health plan does require this type of activity, they do
have the right to require a particular third party for this purpose because
certain business level editing would also probably be built into the
software used by the third party that was specific to that particular
payer. Not all third party vendors would have that specific editing
functionality because they had not been working hand in hand with that
specific health plan. The bottom line is that validation and/or
certification is not required by the HIPAA legislation although it is
recommended by the WEDI Testing white papers. Any requirement that is
outside of the scope of the HIPAA legislation would need to be documented
and agreed upon in a Trading Partner agreement.
We need to come to group concensus on this response and post to the web.
3) Testing Survey Status - Get status from Ed Hafner's group as to the
updates suggested by the Steering Committee and put a plan together to
publish.
4) Next Steps for Testing SWG - review the ideas submitted by Brandi Wyatt
and Suzan Ryder. Discuss as a group if we want to undertake one or both
issues and develop a plan of attack.
Thanks and I will talk to ya on Thursday.
____________________________________________
John D. Lilleston
Section Manager - Healthcare EDI
Verizon Information Technologies, Inc.
Phone - (813)979-3225
Fax - (813)978-5570
[EMAIL PROTECTED]
www.VerizonIT.com
____________________________________________
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