Rachel;
Thank you for your reply. I had already gone through the Final Rule and was
aware of the references you made. My concerns about employer non-involvement
in HIPAA stem from my years working for a major health plan, both before and
after working for providers and consulting on information systems. In almost
20 years in health care, I have yet to see employers step up to the plate to
aid a health plan or provider in accessing information - particularly in
markets where employer bases are fragmented and there's a lack of organized
forums where providers and payers can make their point heard to the employer
base. So it will be interesting to see how the employee/human resource
information side of HIPAA performs, both from the transaction side and
privacy/security side.
-----Original Message-----
From: Rachel Foerster [mailto:[EMAIL PROTECTED]]
Sent: Friday, September 01, 2000 1:35 PM
To: [EMAIL PROTECTED]
Subject: FW: XML Schemas/DTD for HealthCare Industry
Michelle,
Even the enrollment/disenrollment transaction (834) is covered by HIPAA's
final rules. The key distinction is that employers/plan sponsors are not
required to implement the 834 as the payers are for the others. The 834 has
already been implemented by many large organizations. There is the
expectation that adoption of the HIPAA 834 format and content will happen
fairly quickly since it standardizes both format and data content for all.
What is not realized by many is the extreme verbosity of an XML formatted
document - the ratio between a traditional X12 EDI transaction to the same
data formatted in XML is almost 20-to-1 with the XML document being 20 times
the data volume. Since the 834 along with the 837 and 835 typically convey
huges amount of data I seriously doubt whether there would be interest in
going to XML for these.
Furthermore, even though employers/plan sponsors are not required under
HIPAA to implement the 834, I expect that the payers will put extreme
pressure on them to adopt it, especially once the payers have converted to
the other HIPAA mandated transactions. There is simply no business cost
benefit to be gained by having to support and maintain multiple formats.
That concept (a single format with standardized data content) is at the
heart of HIPAA. I've also inserted below the actual wording from the final
rule regarding enrollment which may help provide perspective.
Rachel
"Transactions may be used by both
covered entities and other entities. For
example, the enrollment and
disenrollment in a health plan
transaction is most commonly sent by
employers or unions, which are not
covered entities, to health plans, which
are covered entities. The employer may
choose to send the transaction
electronically in either standard or non-standard
format. The health plan,
however, must conduct the transaction
as a standard transaction when
conducting the transaction
electronically with another covered
entity, with another part of itself, or
when requested to do so by any other
entity. Moreover, if an employer or
other non-covered entity desires to send
a transaction as a standard transaction,
the health plan may not delay or
adversely affect either the sender or the
transaction. It is expected that this
provision will encourage non-covered
entities that conduct the designated
transactions with more than one health
plan to conduct these transactions as
standard transactions."
-----Original Message-----
From: Michelle Holtzman [mailto:[EMAIL PROTECTED]]
Sent: Thursday, August 31, 2000 3:27 PM
To: '[EMAIL PROTECTED]'
Subject: RE: XML Schemas/DTD for HealthCare Industry
Rachel;
What about enrollment and disenrollment transactions? Since employers are
exempted from HIPAA at this point, is there any applicability to expediting
that type of information gathering from employers on an electronic basis -
to be translated into the x12 format coming in to payers and health plans.
Am I missing something here? It seems like XML would give some
standardization to a portion of healthcare information that has not been
included in HIPAA.
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