thoughts on business and IT aligment, planning implementation of HIPAA 5010, organizational readiness, preparation for ICD-10 for health plans "payers"
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HIPAA 5010 testing and adoption
1. Managing the Conversion to HIPAA 5010 February 18, 2010 Mike Arrigo Managing Partner, CEO No World Borders, Inc. For more details, assessment info 5010@noworldborders.com (Please send from your payor or provider email domain address) http://www.noworldborders.com/HIPAA5010MigrationServices.html
2. 5010 Topics Planning & organizational readiness Requirement audits & testing Vendor selection cautions What defines production ready? Opportunities http://www.noworldborders.com/HIPAA5010MigrationServices.html
4. Planning:Identify Principles for Stakeholder Interaction Address 4010 to 5010 cutover issues Review current applications, IT projects Design approach Impacted systems Vendors Members Providers Requirements development & audit http://www.noworldborders.com/HIPAA5010MigrationServices.html
5. HIPAA 5010 Implementation Approach Business and IT Alignment – Business, technology, strategies, and resources must be aligned to achieve results. Business roadmap meets IT portfolio mgmt. Process Change and Innovation –Working with people and helping them see a better way to work. Manage Expectations, findquick wins Help the team Visualizethe process to improve buy-in Change Management & Communication – Communicate and distribute critical business knowledge, share the “wins” via social media Best-Practices Measurement – Best practice methods, and testing frameworks http://www.noworldborders.com/HIPAA5010MigrationServices.html
6. Planning – Do Not Underestimate Dec. 31, 2010, payers and providers complete first level testing Conduct internal testing throughout 2010 Once you realize that Level Two testing must be completed by the end 2011, final compliance dates are not so far away http://www.noworldborders.com/HIPAA5010MigrationServices.html
8. Organizational Checklist (1 of 2) http://www.noworldborders.com/HIPAA5010MigrationServices.html Vendor Agnostic Approach Industry Standards Group Membership Experience With HIPAA, Multiple Health Plans X12 Transactions & Acks Experience Understand Association Specific Technologies Vendor Claims System SMEs Understand TR3 Impl. Guides
12. CMS, ICD-9 and ICD-10 experience to understand global “end game” ramificationshttp://www.noworldborders.com/HIPAA5010MigrationServices.html For Bios & Detail Capabilities Contact Us
14. Audit Capabilities Check List:Regulatory Experience & Judgment Understand unique architecture and business organization Perform review of business requirements & artifacts Provide a detailed regulatory gap analysis between: HIPAA 5010 Final Rule and X12 Implementation Guides for HIPPA 5010 covered transactions and acknowledgements) System (i.e., receiving, archiving, validating, transforming, processing and responding) Facilitate defining the steps to complete 5010 Functional Specifications http://www.noworldborders.com/HIPAA5010MigrationServices.html
16. According to Gartner,A large portion of the work effort and cost for HIPAA 5010 will be in testing1 www.noworldborders.com/HIPAA5010MigrationServices.html 13 Majority of HIPAA 5010 testing isn’t about HIPAA compliance. It’s about your back end systems, end to end claims processing . . . etc. 1Version 5010 Regulatory Impact Analysis – Supplement September 2008 This document was prepared by Gartner, Inc., under a contract to the Centers for Medicare & Medicaid Services (CMS)
17. www.noworldborders.com/HIPAA5010MigrationServices.html 14 Ensure You Have HIPAA Testing Thought Leadership On Your Team Quality Assurance Methodology and Framework BRS, Functional requirements System / integration / UAT testing Design documentation End to end testing Test Automation Test Data Management Trading Partner Testing / On boarding Reusability of Artifacts for ICD-10
21. Market Intelligence Laggards Lack of business & IT alignment CIO short term budget concerns Just getting started in understanding the landscape of vendors and approaches Leaders: Working to beat deadlines Investing heavily in process, people, systems Challenged by legacy issues Intent on outsourcing claims processes for laggards, at a profit http://www.noworldborders.com/HIPAA5010MigrationServices.html
23. Issues to Consider HIPAA Transactions Experience: 820, 834, 835, 837 P, 837 I, 837 D, 270/271, 276/277 and 278 transactions and 999, Acknowledgements TA1 277CA Look for people who have lived through NPI, 4010… http://www.noworldborders.com/HIPAA5010MigrationServices.html
24. Impact of HIPAA Title II, Subtitle FWith Respect to 5010 EDI Standards Privacy & Security Transactions Code sets Identifiers Trading partner security & governance risk assessments http://www.noworldborders.com/HIPAA5010MigrationServices.html
26. System Integration &Testing Approach, Ideas The interoperable cloud—tying heterogeneously tested data together with today's Web standards Packaged pathways—extending popular integration tools into the cloud New best practices—ensuring security and availability for dispersed resources Strategic opportunities—focusing on what you do best, using SOA to help with integration issues http://www.noworldborders.com/HIPAA5010MigrationServices.html
27. Prediction Based on Experience Most large IT projects fail on the first attempt Usually, the cause is lack of business & IT alignment Difficult to balance day to day with innovating new business value via IT Talent management plans are an after thought Suggestion for 5010 success: Make an early investment in outside professional guidance on these and other issues identified http://www.noworldborders.com/HIPAA5010MigrationServices.html
28. No World Borders 5010 Consulting Services Strategic Planning Project Management Subject Matter Experts Auditing & Testing of for 4010 to 5010 Team Experience with ~ 25 health plans and providers Private Equity backing with 10 years’ experience 25
30. Mike Arrigo Managing Partner, CEO No World Borders, Inc. For more details, assessment info 5010@noworldborders.com (Please send from your payor or provider email domain address) noworldborders.com/HIPAA5010MigrationServices.html
32. www.noworldborders.com/HIPAA5010MigrationServices.html 29 Track Record Founded 2000 “Real life” experiences with NPI & HIPAA implementation Recent success story: Excellus BCBS Experience with several different Blues Seven claims systems implementations Backed by Private Equity Firm, Strong Financials Consultants in U.S., Latin America, E.U., Asia 29 No World Borders
41. www.noworldborders.com/HIPAA5010MigrationServices.html 31 Audit Quality Assurance & Testing100 Years Collective Experience in Audits & Quality Assurance Healthcare, Financial and Pharmaceutical Verticals Pharmaceutical & Healthcare testing Configuration, Release Management Test Data & Automation Management Team participates in WEDI transaction & testing work groups Accomplishments Team created CCAP Testing Methodology Tested all Major EDI Translators and Validators for 4010A Original “Certifier of Certifiers” Process Author of HIPAA Reference Book Assisted Numerous Covered Entities and Vendors with Compliance
48. 33 Process & Compliance Expertise Process improvement & claims implementation team consultants, former consultants to 21 Blues including: Alabama Blue Shield of CA CareFirst Excellus Georgia Louisiana Hawaii Indiana Premera Rhode Island Nebraska Michigan