News | January 05, 2009

CAQH, HIMSS, IHE, Blue Cross Test New HIPAA Standards in Action

January 6, 2009 – The organizations CAQH, the Healthcare Information and Management Systems Society (HIMSS), the Integrating the Healthcare Enterprise (IHE) Initiative and the Blue Cross and Blue Shield Association (BCBSA) will collaborate with the Centers for Medicare and Medicaid Services (CMS) on the formation of a 5010 Testing Project to address real-time testing of the new X12 HIPAA 5010 transactions implementation.

The groups will demonstrate ways to implement the 5010 HIPAA transaction standards using CAQH’s Committee on Operating Rules for Information Exchange (CORE) Phase I and II rules certification testing scripts, the IHE interoperability framework and Interoperability Specifications developed by the Healthcare Information Technology Standards Panel (HITSP).

“This testing project will be presented at the 2009 IHE North American Connectathon to demonstrate that current, multi-stakeholder industry collaboration is producing real-world results and having a long-term, positive impact on healthcare capabilities,” said Didi Davis, senior director, IHE for HIMSS.

The project aims to show the synergies between 5010 guidelines and existing testing and certification efforts – initiatives that already have begun to support HIPAA 5010 transactions such as the use of patient financials.

CORE, launched by CAQH, is a nationwide all-payer solution to improve provider access to electronic patient administrative and payer information before or at the time of service using any technology they choose. CORE’s Phase I and II rules – which incorporate some of the 5010 requirements and complement existing IHE and HITSP work – are already being used in the marketplace.

CORE certification testing scripts enable appropriate healthcare entities like Blues plans to demonstrate adoption. Using the larger IHE framework, the collaborators can demonstrate the path the industry has set to have interoperability within and between clinical and administrative data.

“This project is a great example of how public and private stakeholders can work together to insure that standards are effective in real-world application before implementation,” said CAQH Executive Director Robin Thomashauer.

The collaboration has identified four goals for the 5010 Testing Project, including:
• Initiating industry and market momentum for the adoption of the 5010 HIPAA transaction requirements and the complementary CORE rules certification process;
• Providing an avenue to demonstrate current industry capabilities for HIPAA-compliant administrative data exchange with multi-stakeholder participation through the 2009 North American Connect-a-thon and the 2009 HIMSS Interoperability Showcase;
• Highlighting the 5010 testing options in conjunction with the CORE Phase I and II rules testing scripts and testing tools already available to the market; and
• Displaying private-public collaboration, and the critical role that voluntary, private sector-led efforts like HITSP, IHE and CORE play in the national landscape.

CMS issued on August 22, 2008 a proposed rule that would adopt updated versions of the standards for electronic transactions under the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The updated standards would replace the current standards, and would promote the efficiencies needed in electronic transactions.

For more information: www.himss.org

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