HIPAA consulting and implementation

Silicus provides end-to-end consulting and implementation services of these transaction sets for HIPAA 5010 version upgrade, in order to assist you meet the regulatory deadline.

• 270/271 - Health Care Eligibility Benefit Inquiry and Response
• 276/277 - Health Care Claim Status Request and Response
• 278 - Health Care Services – Request for Review and Response; Health Care Services Notification and Acknowledgment
• 834 - Benefit Enrollment and Maintenance
• 835 - Health Care Claim Payment/Advice
• 837 - Health Care Claim (Professional, Institutional, and Dental), including coordination of benefits (COB) and subrogation claims

Assessment

HIPAA 5010 upgrade is aimed to streamline the claim administration and payment processes across providers, payers, sponsors and administrators. Silicus provides below services for 5010 upgrade assessment:

• Identify the systems, policies and processes including database, source-code, 4010 schemas and reports that require modification to accommodate HIPAA 5010 standard
• Evaluate readiness of business partners, including clearinghouses, software vendors, etc., to confirm that they are also prepared for the transition
• Review current EDI processing environment and production systems to assess EDI translation, trading partner profiles, internal data formats, interchange control and mappings in order to draw migration plans.
• Develop business-specific migration roadmap for technical and business components that have been identified to be impacted by the transition to HIPAA 5010

Remediation

• Develop 5010 versions of all required EDI translation maps and business processes
• Customized solution for 5010 upgrade to provide business continuity throughout the transition and ensure minimal impact to productivity and customer-partner satisfaction
• Enhancements to core processing (or back-end) EDI systems to meet HIPAA 5010 compliance and upgrading the front-end systems in order to process 5010 transactions.
• Consulting and implementation services for HIPAA BizTalk (Microsoft) Accelerator which provides built-in support to achieve HIPAA transactional compliance.

Testing

• Testing plan to comply with compliance testing types defined by WEDI (Workgroup for Electronic Data Interchange)
• Create 5010 test data from 4010A1 production data
• Scenario-based 5010 testing for trading partners