HIPAA Implementation Guide - Oracle

HIPAA Implementation Guide

Release 4.5.3

SeeBeyond Proprietary and Confidential

The information contained in this document is subject to change and is updated periodically to reflect changes to the applicable software. Although every effort has been made to ensure the accuracy of this document, SeeBeyond Technology Corporation (SeeBeyond) assumes no responsibility for any errors that may appear herein. The software described in this document is furnished under a License Agreement and may be used or copied only in accordance with the terms of such License Agreement. Printing, copying, or reproducing this document in any fashion is prohibited except in accordance with the License Agreement. The contents of this document are designated as being confidential and proprietary; are considered to be trade secrets of SeeBeyond; and may be used only in accordance with the License Agreement, as protected and enforceable by law. SeeBeyond assumes no responsibility for the use or reliability of its software on platforms that are not supported by SeeBeyond.

e*Gate, e*Index, e*Insight, e*Way, e*Xchange, e*Xpressway, iBridge, IQ, SeeBeyond, and the SeeBeyond logo are trademarks and service marks of SeeBeyond Technology Corporation. All other brands or product names are trademarks of their respective companies

? 2002 by SeeBeyond Technology Corporation. All Rights Reserved. This work is protected as an unpublished work under the copyright laws.

Portions of this software are copyrighted by Intalio, 2000?2002

This work is confidential and proprietary information of SeeBeyond and must be maintained in strict confidence.

Version 20020828132242.

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Contents

Contents

List of Tables

Chapter 1

Introduction

Introduction to HIPAA

Intended Reader

Supporting Documents

Chapter 2

HIPAA Overview

Introduction to HIPAA

What Is HIPAA? HIPAA Goals

Electronic Health Transactions Standards Unique Identifiers Security and Electronic Signatures Privacy and Confidentiality Trading Partner Agreements

HIPAA X12

Sample Scenario Batch and Real-Time Transactions

Batch Real-Time Data Overview

Acknowledgment

NCPDP

What Is NCPDP? History What Is the NCPDP Telecommunications Standard? Components of an NCPDP Envelope

Structure of a Request Transaction Structure of a Response Transaction Batching in NCPDP Acknowledgment Types Transaction Codes

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Additional Information

Chapter 3

The SeeBeyond Solution

Introduction

e*Xchange Partner Manager e*Gate Integrator e*Index Global Identifier

e*Xchange Partner Manager

e*Xchange Files for HIPAA Transactions The e*Xchange HIPAA e*Way The HIPAA ETD Library Complete HIPAA Transaction ETDs

e*Gate Integrator

e*Gate Files for HIPAA Transactions

Testing the SeeBeyond Solution

Chapter 4

e*Xchange HIPAA Validations

Overview

Validated Transaction Sets HIPAA Validations Summary

External Code Set Validations

Code Set Modifiers Code Set Validations

Data Pattern Validation Date/Time Pattern Validations Balancing Validations HL Segment Validations Conditional Validations HIPAA Unique Identifier Validations

About National Identifiers National Identifiers in e*Xchange National Identifiers and Transaction Sets

Validation Error Reporting

The HIPAA Validation e*Way Validation e*Way Error Message Format Understanding the Error Message

Message Tracking Message Tracking Error Message Format

Log File Error Messages

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HIPAA Validation Rules Implementation Notes

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Loop Trigger Validations

39

Rules Clarifications

40

Chapter 5

Processing Large Transactions

53

Overview

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Considerations

53

Methodology

54

Source System e*Way Requirements

54

Translation Requirements

54

Splitting the Message

54

Post-Processing

54

Implementing Large Message Processing

55

Trading Partner Attributes

55

Message Profile Settings

56

Customizing Large Message Processing Components

57

Source System e*Way

57

Large Message Collaboration

57

Monk Splitter Function

58

Chapter 6

e*Xchange Implementation

59

Overview

59

Case Study: Sending a Health Care Claim

59

Verify the e*Gate and e*Xchange Installation

61

Installing the Sample Files

62

Create the Trading Partner Profiles

63

Trading Partner Information Hierarchy

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Step 1: Create the Company

64

Step 2: Create the Trading Partner

65

Step 3: Set up the Inbound B2B Protocol Information

65

Step 4: Create the Inbound Message Profiles

66

Step 5: Set Up Outbound B2B Protocol Information

67

Step 6: Create the Outbound Message Profiles

68

Step 7: Configure Return Messages for Inbound

70

Clone the eXSchema

71

Configure the Internal_Order_Eater e*Way

71

The e*Xchange Internal_Order_Eater e*Way

71

Step 1: Create and Configure the Internal_Order_Eater e*Way

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Step 2: Create the Internal_Order_Eater Collaboration Rule Script

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Step 3: Create the Internal_Order_Eater Collaboration Rule

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Step 4: Create the Internal_Order_Eater Collaboration

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