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HIPAA Authorizer

1. de Inbox Manager PES Check EDI File Loading EDI Files into Inbox Processing Inbox Select and Check EDI File Download from FTP Server Process Inbox Activity Log and Warnings The Inbox Manager window Read more in e Downloading EDI Files From FTP Server e Processing EDI Files e Selecting and Checking EDI Files Checking EDI Files EDI file analysis based on the HIPAA standards Compliance with HIPAA EDI rules is an essential part of the exchange of EDI documents The standards are the only agreed upon rules that sender and receiver use to exchange data from completely different backend systems Strict adherence is therefore necessary to guarantee frictionless operation Unfortunately HIPAA compliance is difficult and the truth is that many HIPAA EDI files are truly bad Syntax errors omitted loops missing elements wrongly formatted elements these are the most common EDI errors Without a true analysis it is difficult to say what data ends up in your system EDI Exchange has a built in compliance engine that analyzes each incoming and outgoing EDI transaction Line by line element by element error reporting provides a powerful tool to determine the quality of the incoming and outgoing EDI files All HIPAA file versions are supported The compliance check creates a detailed report that lists every lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 254 compliance issue Outgoing fil
2. 1 After saving the Send EDI button will be active To send the newly saved file click it This will send your EDI request to your trading partner via the method you specified when setting up the selected Trading Partner If MIME or SOAP was selected the file will be sent through the RealTime Client to the Trading Partner s MIME or SOAP service lt 2013 gt Martin Scholl Consulting Inc 275 HIPAA Authorizer 12 Issue Tracking 12 1 Reporting an Issue HIPAAsuite like to make bug fixes fast and transparent For this purpose we include an Bug tracker with the HIPAA Eligibility Responder btnet Bugtracker in ASP Net is an open source project HIPAAsuite implemented Bugtracker Net in all its products to track bugs and enhancements One of the reason we liked btnet was the screen capture capabilities We adapted and included this facility You can reach the Issue Tracker under the Help menu tup El j About Check For Updates Report an Issue Ctrl 1 Figure 1 The menu for the issue tracker Please remember the shortcut Ctrl to call the Issue tracker Some screens do not give you access to the menu while they are open but the key combination Crtl will call up the issue tracker report screen lt 2013 gt Martin Scholl Consulting Inc Issue Tracking O BugTracker NET Screen Capture Save as Copy to Clipboard Draw with mouse while pressing any key red arrow v Undo Li
3. lt 2013 gt Martin Scholl Consulting Inc Database Integration no Requester_FollowUpCode2 char 1 NULL Requester_RejectReason3 char 2 NULL Requester_FollowUpCode3 char 1 NULL Requester_RejectReason4 char 2 NULL Requester_FollowUpCode4 char 1 NULL Requester_RejectReason5 char 2 NULL Requester_FollowUpCode5 char 1 NULL Requester_RejectReason6 char 2 NULL Requester_FollowUpCode6 char 1 NULL Requester_RejectReason7 char 2 NULL Requester_FollowUpCode7 char 1 NULL Requester_RejectReason8 char 2 NULL Requester_FollowUpCode8 char 1 NULL Requester_RejectReason9 char 2 NULL Requester_FollowUpCode9 char 1 NULL SubscriberName varchar 35 NULL SubscriberFirstName varchar 25 NULL SubscriberMiddleName varchar 10 NULL SubscriberSuffix varchar 10 NULL SubscriberlDQual char 2 NULL SubscriberlD varchar 30 NULL SubscriberOtherlDQual varchar 3 NULL SubscriberOtherlD1 varchar 30 NULL SubscriberOtherlDQuaQ varchar 3 NULL SubscriberOtherlD2 varchar 30 NULL SubscriberOtherlDQuaGB varchar 3 NULL lt 2013 gt Martin Scholl Consulting Inc 111 HIPAA Authorizer SubscriberOtherlD3 varchar 30 NULL SubscriberAddress1 varchar 55 NULL SubscriberAddress2 varchar 55 NULL SubscriberCity varchar 30 NULL SubscriberState char 2 NULL Subscri
4. Scheduled Task Wizard Type a name for this task The task name can be the same name as the program name OJHIPAAE nrolmentMaster The Scheduled Task Wizard window 6 Enter the name and password of a user The task will run as if it were started by that user Click Next lt 2013 gt Martin Scholl Consulting Inc 177 HIPAA Authorizer Scheduled Task Wizard Ca a not nun The Scheduled Task Wizard window 7 In the last screen make sure you have specified all data correctly Click Finish to Save your task Scheduled Task Wizard You have successhully scheduled the following task HIPAAEnsollmertMaster Run at user logon j Open advanced properties for this la Finish Chek Finish to add the tack to pour Window schedule The Scheduled Task Wizard window 8 The scheduled task has been added to the system Now let s edit the new task and add the desired command line arguments with the appropriate options Double click the newly created task in the Scheduled Tasks window lt 2013 gt Martin Scholl Consulting Inc Automation 178 scheduled Tasks lol x File Edit View Favorites Tools Advanced Help lt del T JO search Folders Fi Bias heduled Task Other Places A E coogleUpdateTaskLiserS 1 5 AL 7 42 PMeveryd 7 42 00 PM Never gt Control Panel GLiGoogleUpdateTaskUserS 1 5 At 3 07 PM every d 3 07 00 PM Never i HIP
5. lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer Review Delivery Ambulance Chiropractor DME Oxygen Oxygen Therapy Conditions Home Oxygen Therapy Information Conditions requiring Oxygen Therapy 25 ltem has been prescribed as part of a planned regimen of treatment in patient home The above conditions Apply O Do not Apply Oxygen Condition Codes The information in this part of the oxygen screen goes into a CRC segment with the qualifier 11 The second half of the screen is more specific to the home oxygen therapy and equipment lt 2013 gt Martin Scholl Consulting Inc Oxygen Therapy Conditions Oxygen Equipment Type 1 D Liquid Portable Oxygen Use Oxygen Flow Rate Liters Minute Daily Oxygen Use Count Number of Hours per Use 1 Description Oxygen Test Oxygen Test Condition N No special conditions for Test Portable Oxygen Equipment Portable Oxygen System Flow Rate liter min 12 Home Oxygen Therapy Information Oxygen Eqipment Type 2 A Nasal Canula Response Mode Viewing Requests 74 Home Oxygen Therapy Information Eqipment Reason Description Blood Gas Arterial Blood Gas Qty Oxygen Saturation Qty 87 Oxygen TestFindings 1 to 3 Oxygen Equipment Type Information from here comes from the CR5 segment 3 5 7 Functional Limitations Often a request for medical services has to be justified with the patients condition The functional limit
6. UMOName_RejectReason8 char 2 NULL UMOName_FollowUpCode8 char 1 NULL UMOName_RejectReason9 char 2 NULL UMOName_FollowUpCode9 char 1 NULL RequestorEntitylD char 2 NULL RequestorName varchar 35 NULL RequestorFirstName varchar 25 NULL RequestorMiddleName varchar 10 NULL RequestorSuffix varchar 10 NULL lt 2013 gt Martin Scholl Consulting Inc 109 HIPAA Authorizer RequestorlDQual char 2 NULL RequestorlD varchar 30 NULL RequestorOtherlDQual1 varchar 3 NULL RequestorOtherlD1 varchar 30 NULL RequestorOtherlDQual varchar 3 NULL RequestorOtherlD2 varchar 30 NULL RequestorOtherlDQualB varchar 3 NULL RequestorOtherlD3 varchar 30 NULL RequestorAddress1 varchar 55 NULL RequestorAddress2 varchar 55 NULL RequestorCity varchar 30 NULL RequestorState char 2 NULL RequestorZip varchar 15 NULL RequestorCountry varchar 3 NULL RequestorSubdivision varchar 3 NULL RecieverContact varchar 60 NULL RequestorTelefone varchar 20 NULL RequestorExtension varchar 10 NULL RequestorFax varchar 20 NULL RequestorEmail varchar 60 NULL RequestorURL varchar 100 NULL RequestorProviderCode char 2 NULL RequestorProviderTaxonomy varchar 30 NULL Requester_RejectReason1 char 2 NULL Requester_FollowUpCode1 char 1 NULL Requester_RejectReason2 char 2 NULL
7. UMO_RequestValid3 char 1 NULL UMO_RejectReason3 char 2 NULL UMO_FollowUpCode3 char 1 NULL UMO_RequestValid4 char 1 NULL UMO_RejectReason4 char 2 NULL UMO_FollowUpCode4 char 1 NULL UMO_RequestValid5 char 1 NULL UMO_RejectReason5 char 2 NULL UMO_FollowUpCode5 char 1 NULL UMO_RequestValid6 char 1 NULL UMO_RejectReason6 char 2 NULL UMO_FollowUpCode6 char 1 NULL UMO_RequestValid7 char 1 NULL UMO_RejectReason7 char 2 NULL UMO_FollowUpCode7 char 1 NULL UMO_RequestValid8 char 1 NULL UMO_RejectReason8 char 2 NULL UMO_FollowUpCode8 char 1 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 108 UMO_RequestValid9 char 1 NULL UMO_RejectReason9 char 2 NULL UMO_FollowUpCode9 char 1 NULL UMOName_RejectReason1 char 2 NULL UMOName_FollowUpCode1 char 1 NULL UMOName_RejectReason2 char 2 NULL UMOName_FollowUpCode2 char 1 NULL UMOName_RejectReason3 char 2 NULL UMOName_FollowUpCode3 char 1 NULL UMOName_RejectReason4 char 2 NULL UMOName_FollowUpCode4 char 1 NULL UMOName_RejectReason5 char 2 NULL UMOName_FollowUpCode5 char 1 NULL UMOName_RejectReason6 char 2 NULL UMOName_FollowUpCode6 char 1 NULL UMOName_RejectReason7 char 2 NULL UMOName_FollowUpCode7 char 1 NULL
8. Email URL Additional Identifiers ID Qualifier gt Add Delete Save Requester into Database The Requester screen The requester is typically a provider who want to establish insurance coverage for a certain procedure Alternatively there are third party organizations that specialize in authorizations and create them for others Usually the requester is the person getting the response back The above screen has fields for name and address provider type and specialty identifiers and contact information The fields are pretty much self explanatory Next to the specialty field is a button that when clicked will bring up a list with all provider taxonomy codes and their descriptions lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 30 1035A1400N 103541800N oem The specialty or taxonomy screen The requester information can be stored in the database and recalled for the next transaction In the bottom right corner of the screen is the button Save Requester to Database This will save the entry to the table Authrequester The next time one types into the last name field or the ID field previously stored records appear as a drop down choice and will fill all the fields that have been saved lt 2013 gt Martin Scholl Consulting Inc 31 HIPAA Authorizer 2 4 Subscriber Patient screen The subscriber screen consists of several parts When we
9. HIPAA Authorizer Manual Software for the 278 Authorization and Review Request Copyright Martin Scholl Consulting Inc 1 HIPAA Authorizer Table of Contents Part O ON OO OF FP WD N Part Il oa fF Q N 10 11 12 13 Foreword 0 The HIPAA Authorizer 2 INTOdUCION aiia A 2 Software TAA eiiie E AE 6 Featuresand LICENSES osiris orci ne aa 9 ADPDIICANON SCORE ia 11 Company SetUP anta iia 12 Edit Mode Sella o odias 16 Delimiters STUD una 17 Code Malhtenance aii aoocads 17 TRS EDI EGON canica 20 Creating Authorization Requests 25 Regest MOOG roroi e EE aE a E aE E EEAS 25 Staring a NEW REGUE SI iia 27 Reduester creen rs 29 Subscriber Patient Screen iii 31 Subscriber Patient AUTO COMPlete comino iaa ci 34 Patent Event LEVE anasonara aran 35 Review Request Sereen ice aoaaa a Aaa aaa ahe aaa Aaaa aA A aaa A a EROE dani 35 Health Service DellVefy signe a e a a aaa 37 AmbulanCe Service sics A A Aa AAEN aOR 39 CRIROPFAGCC Servite Sasarina a id 39 Durable Medical Equipment iii A A A AAA da 40 Ds A nn E a 41 Functional LIM IAW ONS ici a a Aid 43 Mental Status a ao aaia 44 Home AS A dia 45 PLOMO ES 1 ula stccatuncbecweack er blewae te uuene eve cee pean cuuneuewpuebarsousueussecuemeveeweus 46 OMerUMO oisinn arcean raner aE EAE ANE EAEE E 46 Serice Event Le v locana E EREE AEEA 47 Service De O 47 Procedures ca 49 Health Service D livery Detall iana A a 50 Message Paper Work rnio ideia eaa a aa a ae ra a Rene
10. varchar 30 NULL Provider2OtherlDDesc3 varchar 80 NULL Provider2Address1 varchar 55 NULL Provider2Address2 varchar 55 NULL Provider2City varchar 25 NULL Provider2State char 2 NULL Provider2Zip varchar 10 NULL Provider2Contact varchar 60 NULL Provider2Telefone varchar 20 NULL Provider2Extension varchar 10 NULL Provider2Fax varchar 20 NULL Provider2Email varchar 60 NULL Provider2URL varchar 100 NULL Provider2TypeCode char 2 NULL Provider2Taxonomy varchar 30 NULL Provider2_RejectReason1 char 2 NULL Provider2_FollowUpCode1 char 1 NULL Provider2_RejectReason2 char 2 NULL Provider2_FollowUpCode2 char 1 NULL Provider2_RejectReason3 char 2 NULL Provider2_FollowUpCode3 char 1 NULL Provider2_RejectReason4 char 2 NULL Provider2_FollowUpCode4 char 1 NULL Provider2_RejectReason5 char 2 NULL Provider2_FollowUpCode5 char 1 NULL Provider2_RejectReason6 char 2 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 126 Provider2_FollowUpCode6 char 1 NULL Provider2_RejectReason7 char 2 NULL Provider2_FollowUpCode7 char 1 NULL Provider2_RejectReason8 char 2 NULL Provider2_FollowUpCode8 char 1 NULL Provider2_RejectReason9 char 2 NULL Provider2_FollowUpCode9 char 1 NULL Provider 3 Provider3EntitylD char 2
11. Additional Identifiers REF ID Qualifier ID Type Demographic Information DMG DOB y Sex Save Subscriber into Database _ The part of the form dealing with the subscriber information Most fields are self explanatory Fields such as Employment Status Country Code and Subdivision are normally not required or used The information can be saved into the database in the table Authsubscribers Once you start typing in the last name field a drop down appears where you can select previously saved subscribers In the top left corner is a check mark Subscriber is Patient When this is unchecked the tab with the dependent information appears Dependent Additional Patient Information Last First Middle Sufix DOE JANE K DOB Sex Relationship Birth Order 12 19 1988 E F Female 19 Child Address City State Country Code Subdivision Additional Identifiers ID Qualifier ID Type ID Code Save Dependent into Database The dependent screen Again here the fields are self explanatory Dependent data can be saved to the database for later retrieval just like the subscriber information lt 2013 gt Martin Scholl Consulting Inc 33 HIPAA Authorizer The last tab is called Additional Patient Information Here we have space for a free form text message and notices of additional paperwork and reports that are separate from this request such as X rays or diagnostic reports Text Message
12. In the opened file selection dialog select an EDI file and click Open 3 In the Inbox Manager you can see the result messages for the operation The details are displayed in the Activity Log and Warnings area Check EDI File Loading EDI Files into Inbox Processing Inbox Select and Check EDI File Download from FTP Server mi pii Activity Log and Warnings Filename 140123142208h x12 SEF file HIPAAClaimMaster SEF_Files 837_005010X222A1 SemRef SEF loaded for transaction set 005010X222A1 The Transaction type is 837 Version 005010X222A1 Passed No Errors No Warnings The file has 1 interchanges 1 Functional Groups and 1 Transaction Sets The file contains 4 Claims The Activity Log and Warnings area displaying log messages 10 6 3 Downloading EDI Files From FTP Server EDI Exchange Inbox Manager allows you to load EDI files into the Inbox folder and process these files Be sure you have setup FTP settings in the Remote FTP tab of the Trading Partner window see Setting up Trading Partners Follow the instructions below to upload EDI files into the Inbox folder lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 256 1 Access the Inbox Manager by clicking the Inbox Manager under the EDI Exchange menu EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files ED Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables
13. Inc Database Integration 132 LOINC_Code8 varchar 10 NULL LOINC_Code9 varchar 10 NULL LOINC_Code10 varchar 10 NULL LOINC_Code11 varchar 10 NULL LOINC_Code12 varchar 10 NULL SVx ClaimType char 1 NULL RevenueCode varchar 15 NULL ProcedureCodeType varchar 2 NULL ProcedureCode varchar 15 NULL Modifier1 char 3 NULL Modifier2 char 3 NULL Modifier3 char 3 NULL Modifier4 char 3 NULL ProcedureDescription varchar 80 NULL Amount decimal 8 2 NULL Unit char 2 NULL Quantity varchar 15 NULL UnitRate varchar 10 NULL DiagPointer1 char 2 NULL DiagPointer2 char 2 NULL DiagPointer3 char 2 NULL DiagPointer4 char 2 NULL OralCavityDesignation1 char 1 NULL OralCavityDesignation2 char 1 NULL OralCavityDesignation3 char 1 NULL lt 2013 gt Martin Scholl Consulting Inc 133 HIPAA Authorizer OralCavityDesignation4 char 1 NULL OralCavityDesignation5 char 1 NULL PCI_Code char 1 NULL ReasonForPlacement varchar 80 NULL ToothNumber varchar 96 NULL Surface varchar 512 NULL EPSDT char 1 NULL NursingHomeStatus char 1 NULL CareLevel char 2 NULL HSD HSDQuantityQualifier char 2 NULL HSDQuantity bigint NULL HSDUnitCode char 2 NULL HSDSampleModulus varchar 6 NULL HSDTimePeriodQualifier varchar 2 NULL
14. Invalid Missing Date s of Service 56 Invalid Missing Date of Birth 60 Date of Birth Follows Date s of Semice 61 Date of Death Precedes Date s of Service 62 Date of Semice Not Within Allowable Inquiry Period 64 Invalid Missing Patient ID 65 Invalid Missing Patient Name 66 Invalid Missing Patient Gender Code Fo Patient not Found ___ 66 Duplicate Patient ID Number 69 Inconsistent with Patients Age r r Reject reasons Next to the HCR segment we have additional date information and reference numbers 4 4 View EDI File If you are parsing a 278 EDI file and you want to look at the raw data click on the menu bar View gt EDI file If there is no open EDI file this option is not enabled lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer You will see the following screen al File H HIPAAsuite HIPAAsuiteCommDir Outbox 278 HPS_20141202_170422_278_5010_SUBMITTERS D 278 940 1 ISA 00 00 ZZ HIPAASUITE ZZ SUBMITTERS ID 010101 0001 00501 336170420 0 T 2 GS HI HIPAASUITE SENDER CODE 00010101 0001 433600002 X 005010X217 3 5T 278 0001 005010X217 4 BHT 0007 11 433600002 00010101 0001 18 5 HL 1 20 1 6 NM1 X3 2 HIPAASUITE 46 521685500 7 PER IC MARTIN SCHOLL TE 3016139572 EM MARTIN SCHOLL HIPAASUITE COM 8 HL 2 1 21 1 9 NM1 1P 1 GARDENER JAMES 24 900012345 10 REF 1G 123456 11 REF 1J 223457 12 PRV CO PXC 203BS0133X 13 HL 3 2 22 1 14
15. J CODI es in Line 24 gt NM1 QC 1 DEMO JOHN MI 123456789 at Position 8 DESCRIPTION Value 123456789 not found in Data armunn im Lima DA gt NM 1 N021 NEM O INHN t t 44121 92ARR720 st Pncitinn 2 IMESORIPTION Mavirmiinm lansth nf data alamant ic od q mm p 1 Files processed EDI compliance check results after further processing was aborted Files without a valid trading partner will be placed into the suspended files directory The final action taken after the analysis is recorded at the end of the results Waming In Line 107 ONT N4 050244 IZ0UUS al FOSMION 1 IEDF IUN aa element 3354 designatea NOLUSEO CONTIN date Warming in Line 167 gt LIN N4 63629126003 at Position 2 DESCRIPTION No data in mandatory data element 235 in Data Segrr Warming in Line 168 gt SE 166 031111112 at Position 2 DESCRIPTION Transaction set Message header control number 0001 di Warming in Line 169 gt GE 1 1 at Position 2 DESCRIPTION Functional group header control number 00001 does not match traile The file has 1 Interchanges 1 Functional Groups and 1 Transaction Sets The file contains 4 Claims The file was moved to H H IPAAsuite HIPAAsurteCommDinSuspense 3 keyhealth 837 on 10 17 2012 at 9 50 AM 1 alle This file s processing was aborted The file was moved to the suspended files folder 10 4 4 Certificate based authentication in SFTP SFTP or FTP over secure shell as it is also known is de
16. Martin Scholl Consulting Inc Working with stored requests 150 1 SELECT TOP 20 FROM EDI_AuthorizerHeader Headerld TraceOriginator TracelD TraceReference 1 8 2014 10 01 AM TramsactioniD UMOName UMOIDQuAl rs RequestorEnttyID 2B RequestorName OBA ReauestaF stame Accessing the request records in the database Database records are editable Just double click into any fields and the editor comes up 154 4 l A AL Editing a database record You can query the database in two ways If it is any of the 7 fields on the above screen just type the sought after value and click the Query button next to it You will see that the query on top of the screen The other way is to click on the Define Query tab and now every field in the table is lt 2013 gt Martin Scholl Consulting Inc 151 HIPAA Authorizer 6 2 accessible and can be used for a query Stored Authorizers Define Query Field Use in query Condition Criteria FileName TradingParnernlDQual FileDate FileTime ProcessDate ProcessTime Status Version TransactioniD UMOName UMOIDQual UMOID RequestorEntitylD Requestorwame RequestorFirstName RequestorMiddleMame RequestorSuffix RequestoriDQual RequestorlD RequestorOthenlDQual4 F F T r r F F F r Y Y F F Y Y r F T Define you own query There are four buttons on the top right of the form T
17. NULL AdmitDiagnosisDate date NULL PrincipalDiagnosisCodeType char 3 NULL PrincipalDiagnosisCode varchar 35 NULL PrincipalDiagnosisDate date NULL ReasonForVisitCodeType char 3 NULL ReasonForVisitCode varchar 35 NULL lt 2013 gt Martin Scholl Consulting Inc 117 HIPAA Authorizer ReasonForVisitDate date NULL DRGCodeType char 3 NULL DRGCode varchar 35 NULL DRGDate date NULL DiagnosisCodeT ype1 char 3 NULL DiagnosisCode1 varchar 35 NULL DiagnosisDate1 date NULL DiagnosisCodeT ype2 char 3 NULL DiagnosisCode2 varchar 35 NULL DiagnosisDate2 date NULL DiagnosisCodeT ype3 char 3 NULL DiagnosisCode3 varchar 35 NULL DiagnosisDate3 date NULL DiagnosisCodeType4 char 3 NULL DiagnosisCode4 varchar 35 NULL DiagnosisDate4 date NULL DiagnosisCodeType5 char 3 NULL DiagnosisCode5 varchar 35 NULL DiagnosisDate5 date NULL DiagnosisCodeType6 char 3 NULL DiagnosisCode6 varchar 35 NULL DiagnosisDate6 date NULL DiagnosisCodeType7 char 3 NULL DiagnosisCode7 varchar 35 NULL DiagnosisDate7 date NULL DiagnosisCodeType8 char 3 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration ons DiagnosisCode8 varchar 35 NULL DiagnosisDate8 date NULL DiagnosisCodeType9 char 3 NULL DiagnosisCode9 varchar 35 NULL DiagnosisDate9 date N
18. NULL Provider3Name varchar 60 NULL Provider3FirstName varchar 35 NULL Provider3MiddleName varchar 25 NULL Provider3Suffix varchar 10 NULL Provider3IDQual char 2 NULL Provider3ID varchar 30 NULL Provider30ther DQual1 varchar 3 NULL Provider3OtherlD1 varchar 30 NULL Provider3OtherlDDesc1 varchar 80 NULL Provider30ther DQual2 varchar 3 NULL Provider3OtherlD2 varchar 30 NULL Provider3OtherlDDesc2 varchar 80 NULL Provider3OtherlDQualB varchar 3 NULL Provider3OtherlD3 varchar 30 NULL Provider3OtherlDDesc3 varchar 80 NULL Provider3Address1 varchar 55 NULL Provider3Address2 varchar 55 NULL lt 2013 gt Martin Scholl Consulting Inc 127 HIPAA Authorizer Provider3City varchar 25 NULL Provider3State char 2 NULL Provider3Zip varchar 10 NULL Provider3Contact varchar 60 NULL Provider3Telefone varchar 20 NULL Provider3Extension varchar 10 NULL Provider3Fax varchar 20 NULL Provider3Email varchar 60 NULL Provider3URL varchar 100 NULL Provider3T ypeCode char 2 NULL Provider3Taxonomy varchar 30 NULL Provider3_RejectReason1 char 2 NULL Provider3_FollowUpCode1 char 1 NULL Provider3_RejectReason2 char 2 NULL Provider3_FollowUpCode2 char 1 NULL Provider3_RejectReason3 char 2 NULL Provider3_FollowUpCode3 char 1 NULL Provider3_RejectReason4 c
19. Open Document The Open button The HIPAA Authorizer can also process each file in a directory and create image files from them Note This option is not available for screen display of records Only database import and image file creation have this option available View Database Code Open Sample Files Fo Open Open Directory New Request Select Printer Exit 2 The Open Directory menu item 3 Select the Image File option in the Output Mode block O Manual Process O Data Export O Show on screen Print 2 Image File s The Image File option lt 2013 gt Martin Scholl Consulting Inc Creating Image Files and PDF s 160 4 Click on the Run button in the task bar or the Process button in the Side bar 5 HIPAA Authorsere 64bit File View Database oa gt wm The Run buttons 5 The Processing Results window displays the report You can find the result TIFF or PDF files in the specified folder Processing Results Processing of the file 2 5_5010_Response edi began at 9 29 2014 11 37 17 AM Records Images will be created Processing ended at 9 29 2014 11 37 24 AM The file D Temp 2 85 Response Files 2014 september 29 2 5_5010_ Response pdf The Trading Partner with the ID 1 2456 769012345 is not set up The Processing Results window lt 2013 gt Martin Scholl Consulting Inc 161 HIPAA Authorizer 7
20. Otherwise click the New button and continue onto step 4 lt 2013 gt Martin Scholl Consulting Inc HIPAAsuite RealTime Client 268 Trading Partners EDI Identifiers Options RemoteFTP Contact Encryption Folders EDI Version 4010 5010 EDI identifiers and Qualifier Trading Partner configuration window populated with some Trading Partners 4 The left side of the Trading Partner configuration window will become available to you for editing Fill in at least the Trading Partners name ISA identifier and qualifier the Trading Partner s application code and finally under the Folders tab the outbox and repository folders to be used for this Trading Partner The Create button underneath these last two fields will automatically fill in the text for you using the Trading Partner s name lt 2013 gt Martin Scholl Consulting Inc 269 HIPAA Authorizer Trading Partners Name and Type Name Required CALHEERS FEDERAL EXCHANGE ARKANSAS Address City EDI File Exchange Method E r Email Addresses to send process results EDI Identifiers Options Remote FTP Contact Encryption EDI Version Ss 4010 5010 EDI identifiers and Qualifier ISA Identifier and Qualifier Record Key ETIN Number and Qualiter Application Sender Code 56502 46 Application Receiver Code 6503 Trading Partner Assigned ID A blank Trading Partner 5 T
21. View EDI File Select Trading Partner Select _ Select Trading Partner Partner Help ISA segment Interchange ID Ack TE Password ID Type Sender ID ID Type Receiver ID EXT E f foos01 093133443 fo fr f GS segment ST segment Sender Code Receiver Code Group Control Not Version Transaction ID 5010 1D cs HI HIPAASUITE 20150403 1334 x 005010x217 st 278 005010X217 a 1 The form to create 278 EDI files from the database After selecting a trading partner click the Go button This will generate a 270 Eligibility request EDI file If the contents are satisfactory save the file lt 2013 gt Martin Scholl Consulting Inc 273 HIPAA Authorizer Create 278 TransactionSets A x Trading Partner Al x 1 SELECT TOP 20 FROM EDI_AuthorizerHeader a Effective Date List of Trading Partner Request e tiecponee aans WEST 2 IJ Fields with will be populated by the process Exit Go Write to File View EDI File setect Trading Partner Select Select Trading Partner Partner Help MISA t cdi Password ID Type Sender ID ID Type Receiver ID Interchange ID Ack T P isa foo y oo zz gt HIPAASUITE zz y TesT mz Ez ooso1 093133443 fo mife Hf GS segment ST segment Sender Code Receiver Code Group Control Not Version Transaction ID 5010 ID Ics Hi HIPAASUITE TEST 20150403 1334 x 005010x217 ST 278 005010x217
22. and your name up to 15 letters or your tax id or anything else Fill in the sender s id qualifier and id e ReceiverlD Type and Receiver ID are your identifier You should get this information from your trading partner e If you want an acknowledgement e Whether this is a test or production file In GS segment you have to add e Sender Code you can repeat here your sender id from ISA_06 e Receiver Code again your trading partner should tell you When in doubt repeat ISA_08 For the BGN segment you will have to fill out e The purpose code of this transaction e Your Time Zone e The action code e and in rare circumstances the Transaction Id of another file that you want to refer lt 2013 gt Martin Scholl Consulting Inc Working with stored requests 154 to Here what a properly filled out form looks like Create 278 TransactionSets 2 6 E i Effective Date Request I Response Fields with t will be populated by the process ISA segment 9 29 2014 Password ID Type Sender ID ID Type Receiver ID Date Time Interchange ID Ack TAP ISA 00 ZZ y SENDER 30 v 461542132 140929 1101 00501 272110145 YT vw GS segment ST segment Sender Code Receiver Code Group Control No Version Transaction ID 5010 ID GS HI SENDER 461542132 20140929 1101 X 005010X217 ST 278 005010X217 The necessary information to create a valid EDI file Now you can hit Go and a few moments later we get the processing resu
23. download one of the following components according to your OS bit depth lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 212 The recommended minimum system requirement for Framework EDI 256 MB RAM 1GB avaiable disk space Windows 2000 2003 2008 AP Vista en sites Sor Tyre may quis Micmecd Padisribotmbla Package co be imetalled dr 10 mupporr Prerec Sites Some ime Alicmec Radipri la Paci imetalled E gt Pramneroak EDNET Ghio dewalead Alco Viral E 2007 Radirtribucible Package 150 O Fenek EM NE 14 52 510 download Mircea Visual C 2010 Radiole Pkr 158 Fimen EDI NET 44 bit download Above Visual C 2005 Rediseibutable Package 1 N Fumero EDI NETA 64 bit download Alicrreof Vimal C 2010 Rediseribut le Pekare 164 3 Download one of the following components you need according to your OS bit depth e Framework EDI Enterprise evaluation 32 bit e Framework EDI Professional evaluation 64 bit 4 Install downloaded components and start again the EDI Exchange initialization procedure 10 3 Configuring EDI Exchange Optional Settings 10 3 1 Setting up Email Notifications EDI Exchange can send emails to operators and trading partners to notify them about files and processing results This functionality of EDI Exchange lies beyond the most basic setup that the initialization checks for For this feature to work properly you need to set up an email server which EDI Exchange communi
24. form text Situational Rule Required when needed to transmit a text message to the UMO about the patient event If not required by this implementation guide do not send lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 52 Requester Info Subscriber Patient Specialty Review Provider Info Other UMO Service Detail Review Info _ _ Professional_ __Instiutonal__ ____Dental_____Delivery Paperwork Msg Text Message PATIENT HAS REPEATED EPISODES OF AMNESIA Paper Work Report Type Transmission Control Number Description 06 Initial Assess AA Available 20030524 012 PDF files 08 Plan of Treatm EL Electronica 20121225 001 protected archive E bl ID EDI 1 JUWHSAFDTP 472 D8 20140203 PWRE D6 AA AC 20030524 012 PDF fles PWK 08 EL AC 20121225 001 protected archive MSG PA TIENT HAS REP al j 2 9 5 Providers Detail Provider information on the service detail level is required when requesting a service provider specialist or specialty entity for this service that is different from the provider specialist or specialty entity identified in Loop 2010EA Patient Event Provider If Loop 2010EA is not valued Loop 2010F must be valued for each service associated with this patient event If information in this screen is not required by the implementation guide it may be provided at the sender s discretion but cannot be required by the receiver The screen is iden
25. i Pe y Foru Mama DOHA Pir 741240 ger Price Paria PTT 24 110 ddr 100 MARKET ST APT 30 TR A Beth Cata er Grier eats Gate 7 A Hogar eg Snes ere Code i EST PA See Marte A Ep ron Race se Tor Pma Ameo dui mol Ce Pame Amara Cr Coverage information riera Addition Typa ce ae Coerage Level Dario pte ndo repage Lere Derprphor A Lara mm 12 00 00 PM Esterri Discs Clare AO oa Coda Pr birras pete Fada Teer i O Seeeserri Paper Feseral Taxpayers IO 454136014 Mart Reason Active ao hE Las guage Ta KODE Ce Dali Fron Deal To dial Eupected Expert Se Uriel Ame per Gown 1508 haga COB ds 3 Select the necessary image in the left navigation pane lt 2013 gt Martin Scholl Consulting Inc 165 HIPAA Authorizer E 83 pdf 4 For pages navigation use the arrow buttons 5 To scale the image use or buttons or define the percent manually i lt 2013 gt Martin Scholl Consulting Inc 167 8 2 HIPAA Authorizer Automation Concepts The HIPAA Authorizer s functions and capabilities can be completely automated Other programs batch files or schedulers can call the HIPAA Authorizer executable and its features can accessed via command line arguments All operations are logged and you can set the program up to create email messages to operators informing them of the actions taken Command line argum
26. 1 NULL Provider1_RejectReason2 char 2 NULL Provider1_FollowUpCode2 char 1 NULL Provider1_RejectReason3 char 2 NULL Provider1_FollowUpCode3 char 1 NULL Provider1_RejectReason4 char 2 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 124 Provider1_FollowUpCode4 char 1 NULL Provider1_RejectReason5 char 2 NULL Provider1_FollowUpCode5 char 1 NULL Provider1_RejectReason6 char 2 NULL Provider1_FollowUpCode6 char 1 NULL Provider1_RejectReason7 char 2 NULL Provider1_FollowUpCode7 char 1 NULL Provider1_RejectReason8 char 2 NULL Provider1_FollowUpCode8 char 1 NULL Provider1_RejectReason9 char 2 NULL Provider1_FollowUpCode9 char 1 NULL Provider 2 Provider2EntitylD char 2 NULL Provider2Name varchar 60 NULL Provider2FirstName varchar 35 NULL Provider2MiddleName varchar 25 NULL Provider2Suffix varchar 10 NULL Provider2IDQual char 2 NULL Provider21D varchar 30 NULL Provider2OtherlDQual1 varchar 3 NULL Provider2OtherlD1 varchar 30 NULL Provider2OtherlDDesc1 varchar 80 NULL Provider2Other DQual2 varchar 3 NULL Provider2Other lD2 varchar 30 NULL Provider2OtherlDDesc2 varchar 80 NULL Provider2OtherlDQualB varchar 3 NULL lt 2013 gt Martin Scholl Consulting Inc 125 HIPAA Authorizer Provider2OtherlD3
27. 170 EM Administrator C Windows system32 cmd exe Microsoft Windows Version 6 1 7661 Copyright c gt 28689 Microsoft Corporation All rights reserved C2 Users Mart in gt The Windows Command Prompt screen The command returns a system code which is not displayed to the users e 1 means error e o means everything went okay Testing the command line requires that you check the log See Application Log In the log you may see a message like following Processing of C EDI Inbox 835 started at 3 12 2012 9 21 11 AM Printer is not found in system Processing stopped at 3 12 2012 9 21 11 AM The log will help you to debug the command line lt 2013 gt Martin Scholl Consulting Inc 171 8 3 8 4 HIPAA Authorizer r Transaction Log o e xs Monday September 29 2014 Get Log SELECT TOP 20 ld UMOName Status RequestorName SubscriberName SubscriberFirstName DependentName DependentFirstName SubscriberID FROM EDI_AuthorizerHeader WHERE Status IS NULL OR Status lt 3 ORDER BY ld SELECT TOP 20 Id UMOName Status RequestorName SubscriberName SubscriberFirstName DependentName DependentFirstName SubscriberID FROM EDI_AuthorizerHeader WHERE Status IS NULL OR Status lt 3 ORDER BY ld The Trading Partner with the ID SUBMITTERS ID is not set up File 278_5010_Request ed processed at 9 29 2014 8 03 28 AM Number of Claims in File 1 The Trading Partner with the ID SUBM
28. 80 NULL CR2 Chiropractic Care TreatmentSeries varchar 9 NULL TreatmentCount bigint NULL SubluxationCode1 varchar 3 NULL SubluxationCode2 varchar 3 NULL TreatmentPeriodUnit char 2 NULL TreatmentPeriodCount bigint NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 120 TreatmentMonthlyCount bigint NULL TreatmentCondition char 1 NULL TreatmentComplication char 1 NULL TreatmentDescription varchar 80 NULL TreatmentDescription2 varchar 80 NULL TreatmentXRayAvailable char 1 NULL CR5 Home Oxygen OxygenEquipment1 char 1 NULL OxygenEquipment2 char 1 NULL EqipmentReason varchar 80 NULL OxygenFlowRate bigint NULL DailyUseCount bigint NULL HourlyUseCount bigint NULL RespiratoryTherapistOrder varchar 80 NULL ArterialBloodGasQty bigint NULL OxygenSaturationQty bigint NULL OxygenTestCondition char 1 NULL OxygenTestFindings1 char 1 NULL OxygenTestFindings2 char 1 NULL OxygenTestFindings3 char 1 NULL PortableOxygenFlowRate bigint NULL OxygenDeliverySystem char 1 NULL OxygenEgipmentT ype char 1 NULL CR6 Home Health PrognosisCode1 char 1 NULL HomeHealthStartDate date NULL lt 2013 gt Martin Scholl Consulting Inc 121 HIPAA Authorizer HomeHealthCertificationFrom date NULL HomeHealthCertificationTo date NULL Skille
29. A defined user that has priviliges to the database Not needed for Microsoft SQL server integrated security e Password Not needed for Microsoft SQL server integrated security e Authorizer Header Table Name The name that you give to your Claim header table A default name is suggested but can be overwritten lt 2013 gt Martin Scholl Consulting Inc 103 HIPAA Authorizer e Authorizer Detail Table Name The name of the table that contains the line information A default name is suggested but can be overwritten e Save Response into database this check mark will enable additional fields in the database that are used to store the response specific data elements After filling in all the information please test the connection by first saving and then clicking on the Test Connection button You cannot export claims before this connection tests successfully 5 4 Field Setup The right side of the database setup lists the fields in the 2 tables We recommend that you select all fields and this way make sure that the complete information possibly in a 278 transaction is stored As previously mentioned when you check Save Response into Database on the left side of the screen you will see additional fields in the right side lt 2013 gt Martin Scholl Consulting Inc Database Integration 104 Fields to be exported Header E Ed Header Data po rd 9 FileName o 4 TradingPartneriDQual WM TraceOrigina
30. Add Service Details no information is added to the request transactions Only when you see that the grid has lines do you get this information saved and converted to the 278 transaction set lt 2013 gt Martin Scholl Consulting Inc 49 HIPAA Authorizer 2 9 2 Procedures The next three tabs refer to the service that is proposed Professional Institutional and Dental procedures can be conveyed Review Info ssional instiional Dental Delivery Paperwork Msq ___ Provider Procedure Code Procedure Description Modifiers 1 through 4 Quantity Unit Charge Amount Nursing Home Level of Care The professional service tab Diagnosis Pointers EPSDT Indicator r institutional Dental Delivery Paperwork Msg Provider Revenue Code Procedure Code Type Procedure Description Modifiers 1 through 4 Unit Rate Nursing Home Status The institutional service tab Charge Amount Nursing Home Level of Care lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 50 Review Info Professional Institutional sg Provider Procedure Code Type AD American Dental Association Codes Procedure Description Quantity Charge Amount Oral Cavity Designation Code Tooth a 2 3 4 5 Prosthesis Crown or Inlay Code Reason for Replacement The dental service tab The fields are self explanatory and reflect the procedures and modifiers that are
31. Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Inbox Manager menu item 2 Click the Download from FTP Server button Inbox Manager Check EDI File Select and creck EDI Fite The Download from FTP Server button lt 2013 gt Martin Scholl Consulting Inc 257 HIPAA Authorizer 3 When the process has been finished the Activity Log and Warnings area displays the report Inbox Manager Check EDI Filie Loading EDI Files into Inbox Processing Inbox Select and Check ED File Process Inbox Activity Log and Warnings 3 Checking FPT servers at 3 40 15 PM 1 Trading Partners are set up for FTP transfer Checking for files at Trading Partner PARTNER1 Successfully connected to PARTNER 1 s FTP directory File test_testedi deleted on server 1 Files moved from FTP Servers into Inbox 1 Files moved from FIP Servers into Inbox C ProgramData HIPAAsuite HIPAA Enrollment W Activity Log and Warnings information 10 6 4 Processing EDI Files EDI Exchange Inbox Manager allows you to process EDI files downloaded to the Inbox folder beforehand Note Once you have saved the auto processing options see Defining Auto Processing Options the files will not only be analyzed but also processed according to the defined settings The auto processing enables you to combine and ru
32. Black Update L Never check for update Save Help The Application Setup screen Here we can setup up e the directory where response files are written to With EDI Exchange enabled this directory is filled in automatically e the handling of processed files and the directory where they are moved to e Whether manual operations are logged command line processing is always logged e Whether the program checks for updates on start up e and finally the color of back ground elements in the display form 15 Company Setup In order to create 278 response files the program needs to have your company setup with all the required information This information is used for the Sender information in EDI files If you have the feature Database enabled this information is stored in the CompanySetup Table if you don t than the information is stored in the Windows registry The menu has under the subject Setup the item Company Setup lt 2013 gt Martin Scholl Consulting Inc Image EDI Exchange He E ie Application Setup h Company Setup Edit Mode Setup Delimiters Setup Company Information Name HIPAASUITE Address1 18910 NEW HAMPSHIRE AVE Address o o City BRINKLOW State MD Maryland E Plus 4 9701 Zip 20862 Contact Information Contact Person MARTIN SCHOLL Telephone 301 613 9572 Ext E Mail MARTIN SCHOLL HIPAASUITE COM The company setup screen You can conf
33. EDI Exchange License Information You can register the product by clicking on the EDI Exchange License Information option under the EDI Exchange menu Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup y Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 190 EDI Exchange License Information option under the EDI Exchange Then the license screen appears In the lower left corner you can find the unique registration number needed to create either trial extensions or final licensing EDI Exchange 1 0 Day s remaining for trial a This software is for evaluation purposes only and has limited functionality You will have to purchase this software if you want to continue using it after a free evaluation has expired ici The license information screen Once you click on Register you can enter the license key that you have previously received via email from us see Requesting EDI Exchange License Click on Register and you will see the registration message in the Result area License Registration Form EDI Exchange ED Exchange is fully functional with certain trial limitations
34. HSDPeriodCount int NULL HSDServicePatternCode varchar 2 NULL HSDTimePatternCode char 1 NULL PWK ReportType1 varchar 2 NULL ReportTransmCode1 varchar 2 NULL ReportID1 varchar 80 NULL ReportDescription1 varchar 80 NULL ReportType2 varchar 2 NULL ReportTransmCode2 varchar 2 NULL ReportID2 varchar 80 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 134 ReportDescription2 varchar 80 NULL ReportType3 varchar 2 NULL ReportTransmCode3 varchar 2 NULL ReportID3 varchar 80 NULL ReportDescription3 varchar 80 NULL ResponseReportType1 varchar 2 NULL ResponseReportTransmCode1 varchar 2 NULL ResponseReportID1 varchar 80 NULL ResponseReportDescription1 varchar 80 NULL ResponseReportType2 varchar 2 NULL ResponseReportTransmCode2 varchar 2 NULL ResponseReportID2 varchar 80 NULL ResponseReportDescription2 varchar 80 NULL ResponseReportType3 varchar 2 NULL ResponseReportTransmCode3 varchar 2 NULL ResponseReportID3 varchar 80 NULL ResponseReportDescription3 varchar 80 NULL MSG Message varchar 264 NULL Provider 1 Provider1EntitylD char 2 NULL Provider1Name varchar 35 NULL Provider1FirstName varchar 25 NULL Provider1MiddleName varchar 10 NULL Provider1Suffix varchar 10 NULL Provider1IDQual char 2 NULL lt 20
35. IN SCHOLLGHIPAASUITE COM HL 2 2 1 NM1L 1P 2 XX 1164740684 HL 3 2822 NM1 TL 1 MORENA BLANCA MI 20638162 DMG D8 19291129 F HL 4 3 EV 1 TRN 1 10000027 1552470001 UM HS 1I 12 12 B HCR NA HI BK 25000 MSG SR A16 NM1 SJ 2 Arimed XX 1407885783 HL 5 4 SS 60 DTP 472 RD8 20141029 20150127 5E 20 0001 51 278 0002 005010X217 4 BHT 0007 11 433700001 20141203 0812 18 HL 1 20 1 6 NM1 X3 2 HIPAASUITE 46 521685500 PERFIC MARTIN SCHOLL TE 3016139572 EM MARTIN SCHOLL HIPAASUITE COM 28 HL 2 1 21 1 ha PA ul 5 w 6 o O gt O N pal J ad ee pad pa j O 100 ws DW DB Ww NNN NJ ee N pal N NNN O UN la w y N oo EDI transaction is created The EDI file is now created Now you can write the this EDI stream to a file It exists so far only in memory Click the Write to file button and you have the choice to either specify the filename and path or to use the settings from EDI Exchange After the file has been written you can click the View EDI File button and see it in the EDI Editor lt 2013 gt Martin Scholl Consulting Inc Creating Image Files and PDF s 158 7 Creating Image Files and PDF s 7 1 Creating Image Files The HIPAA Authorizer displays the EDI document in a page that makes it easy to read the 278 transactions Sometimes it might be useful to have an image of an authorization record stored f
36. Martin Scholl Consulting Inc 215 HIPAA Authorizer Email Notificatior Send email notice of newly arrived Files example email com Recipients EDI Ales with Other Type in Inbox Leave file for other program O Auto process if other program is available Setting up the email recipients The email address will appear in the list lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 216 Email Notificatior Send email notice of newly arrived Files Recipients example email com ED Ales with Other Type in Leave file for other program O Auto process if other program is available Added email recipient 5 Click on the Test button to verify your settings 6 Click on the Save button EDI Exchange Directory Setup Root Directory Path DEDN Email Server Information SMTP Server smtp gmail com Sender s email address example gmail com User Name user Password SMTP server requires Logon Connectto the SMTP server via the SSL protocol Use Port Outgoing Files Other options Validate outgoing files _ Halt records if EDI compliance m warnings are found Reject Incoming Files with more errors than set Count below D EDI Exchange is NOT yet initialized The Save button lt 2013 gt Martin Scholl Consulting Inc Email Notificatior Send email notice of newly arrived Files Recipients example email com EDI Ales with
37. Martin Scholl Consulting Inc 29 HIPAA Authorizer Checking SQL settings and tables Connection settings are checked Trading Partners table is checked TRANS_LOG table is checked TRANS LOG ERRORS table is checked SEND _LOG table is checked 3 The next step of the initialization processes the program checks and if necessary creates the root directory and five sub directories Within these root directories there will be folders for each Trading Partner and type of transactions The location and names of the sub folders are handled in the Trading Partner setup The root folder is specified via the EDI Exchange Setup screen Read more in Defining Root Directory The sub directories that EDI Exchange creates are as follows Mas go m Computer WS2008 C 3 Organize Indude in lbrary Sharewith New folder Name Uy Favorites O A EncryptedFiles 1 31 2013 5 56PM Fie folder g Libraries Le Inbox 1 31 2013 5 56 PM File folder de Outbox 1 31 2013 5 56PM File folder J amp E Computer Le ProcessedFies 1 31 2013 5 56PM File folder A i yy sunendedries 1 31 2013 5 56PM Fle folder y Data D The directory structure of EDI Exchange 4 The next step of the initialization the program checks if the HIPAA EDI compliance engine is properly installed 5 The last thing checked by the system is if the Automatic File Processing options have been set up Read more in Defining Auto Proces
38. NULL Zip varchar 10 NULL FipAddress varchar 50 NULL PutDirectory varchar 50 NULL GetDirectory varchar 50 NULL FipArchive varchar 20 NULL FtpUserName varchar 40 NULL FtpPassword varchar 40 NULL FTPPort varchar 12 NULL Outbox varcharl 50 NULL Execute Script The Execute Script button Notice Creating tables means clicking the Execute Script button in all five tabs of the Create Tables for EDI_Exchange window Then close this window 7 Once the table has been created successfully you will see the following notification The Create Table script success message lt 2013 gt Martin Scholl Consulting Inc 195 HIPAA Authorizer Warning Double execution of a script wipes out the previous table you have created A prompt will warn you before deleting an existing table To Add Remove fields use the Compare Script button Remove the script files once you have created the tables so nobody can destroy the tables by accident Caution The double execution warning message Make sure there are no error messages and the table creation has been completed successfully Compare Script with existing Table HIPAAsuite products go through continual development and improvements Often these changes lead to new fields in the database While it is easy to drop a table and regenerate it with the new fields you will loose all the data in the table To avoid
39. Other Type in Inbox Leave file for other program Auto process if other program is available 217 HIPAA Authorizer Troubleshooting Email Settings lf you have problems with setting up the email server please contact your administrator He She should know values to specify and how to test the settings Below is an example of what happens when the email server does not respond Failure After a time out you get a failure notice After acknowledging the failure you get a more detailed error message in the process result screen etm a Percent Cone Sending email to There was a problem with the email See the log below F380 5ywp o6 gsmtp EHLO 50 mtp gmail com at your service 25 SIZE 35882577 50 8BI1TMIME A50 ENHANCEDSTATUSCODES 50 PIPELINING 25TH OHUNEING 250 SMTPUTFE AUTH LOGINeCRLF gt 530 5 7 0 Must issue a STARTTLS command first p 190s MAIL FROM lt example gmail com gt lt CRLF gt REPT TO example email com gt lt C 530 5 7 0 Must issue a STARTTLS command first p190sm 149 980 5 wp 56 gsmtp 530 5 7 0 Must issue a STARTTLS command first at 805 wp 56 gsmtp RSET lt CRLF gt BUS yw sm The process result screen with a detailed error message lt 2013 gt Martin Scholl Consulting Inc EDI Exchange zie 10 3 2 Setting up Incoming and Outgoing Files Options To check if your files are HIPAA compliant EDI Exchange can run a compliance check on outgoing EDI files For inco
40. Provider Specialty 46 Invalid Missing Provider Phone Number 47 Invalid Missing Provider State 49 Provider is not Primary Care Physician 51 Provider is not on File 52 Service Dates Not Within Provider Plan Enrollm 79 Invalid Participant Identification g7 Invalid or Missing Provider Addess IP Inappropriate Provider Role Rejecting a request on the service provider level Viewing other UMO Information The 278 transaction provides to list other UMO s who might have adjudicated the request before This is quite usual when a second opinion is needed or if a declined authorization is resubmitted In such a case the adjudication infromation of the other UMO s have to be transmitted When we click on the Other UMO tab we will see this screen lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 80 Requester Info Subscriber Patient Patient Event Level Provider Info Other UMO Service Event Level Other UMO Information Other UMO Type Denial Date CA Carrier 05 16 2005 UMO Name Main Denial Reason OM Non covered Service Additional Denial Reasons OM Non covered Service OK Primary Care Service OL Exceeds Plan Maximums Other UMO Type Denial Reason Denial Date CA Carrier il a OM Non covered Service 05 16 2005 The Other UMO screen Again this is a FYI screen only in response mode There is nothing that can be edited The information consists of th
41. Provider3_RejectReason8 char 2 NULL Provider3_FollowUpCode8 char 1 NULL Provider3_RejectReason9 char 2 NULL Provider3_FollowUpCode9 char 1 NULL Additional Patient Info Contact ContactName varchar 60 NULL ContactFirstName varchar 35 NULL ContactMiddleName varchar 25 NULL ContactSuffix varchar 10 NULL ContactIDQual char 2 NULL ContactID varchar 30 NULL ContactAddress1 varchar 55 NULL ContactAddress2 varchar 55 NULL ContactCity varchar 25 NULL ContactState char 2 NULL ContactZip varchar 10 NULL Contact varchar 60 NULL ContactPhone varchar 20 NULL ContactExtension varchar 10 NULL ContactFax varchar 20 NULL ContactEmail varchar 60 NULL CONSTRAINT PK_edi_AuthorizerDetails PRIMARY KEY CLUSTERED lt 2013 gt Martin Scholl Consulting Inc tat HIPAA Authorizer 9 Detailld ASC WITH PAD_INDEX OFF STATISTICS NORECOMPUTE OFF IGNORE_DUP_KEY OFF ALLOW_ROW_LOCKS ON ALLOW_PAGE_LOCKS ON ON PRIMARY ON PRIMARY Creating the Tables The HIPAA Authorizer allows you to create the tables for your database to which it will export the request data After you have defined the connection Parameters and tested that the data connection works you can create the tables by using SQL CREATE TABLE scripts Scripts for three database types are supplied MS SQL Server the open source database
42. Read more in Using FTP Client Encryption Many healthcare related companies use encryption to cloak the content of their EDI files The prevalent method of encryption is PKI Private Key Infrastructure that uses the product of two incredibly large prime numbers as cipher EDI Exchange supports PGP Pretty Good Privacy the leader in PKI products as well as the open source GPG project with its Windows sub project PGP4Win Both are implementations of the same encryption mechanism Read more in Using Encryption File Management EDI Exchange uses a clear directory structure to store EDI files The structure is based on root directories for incoming files outgoing files processed files and suspended files Below these root directories there are subdirectories for each trading partner and then each transaction set Read more in Defining Root Directory and Initializing EDI Exchange EDI Compliance Check EDI standards are strict and precise adherence to the Standards is very important so that any organization can work with them regardless of their backend system software EDI Exchange has a built in compliance engine that checks incoming files for compliance The engine also generates a report listing each problem with the exact location Outgoing EDI files can also be checked and you have an option to withhold individual records that violate the rules Read more in Checking EDI Files lt 2013 gt Martin Scholl Consulting Inc
43. TRN 1 2993939000 1 76 598909 484 3929 UM HS 4 1 11 6B REF BB 939393939 D T P472 D8 200806207 SV 1 HC A0 4 mT The Service Event Level Main screen Here in this screen we see on the bottom a grid that lists the content of each line in EDI format Below is the navigation tool Especially with long hospital service authorizations there can be many lines When we navigate between the individual service lines all the screen in the service event level will reload We can reject a service line If we click the Reject at Service Level the reject screen comes up with the following reasons lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 82 au Request Validation Eo IA 15 Required application data missing 57 Invalid Missing Date s of Service 60 Date of Birth Follows Date s of Service 61 Date of Death Precedes Date s of Service 62 Date of Service Not Within Allowable Inquiry Pet T5 Certification Information Missing The list of reject reasons on the service line level 3 8 2 Professional Procedures If the proposed services falls under the professional claim format CMS 1500 then the procedure information will be entered under the Professional tab pc Paperwork Msc Provider Procedure Code Type AD428 HC HCPCS Code Procedure Description Modifiers 1 through 4 50 Bilateral Procedure
44. The EDI file is now parsed and the individual request records displayed in a grid From here we can work on each request HIPAA Authorizer 64bit iol x File View Database CodeSets Image Setup EDIExchange Log Help Bria ti ER List of Authorization Request Payer ubscriber Subscriber ID Authorization Counter Files DO EMBLEM HEALTH MORENA BLANCA 20638162 No Certification required EMBLEM HEALTH GODLIZIA GENNE 20638174 No Certification required Recods l EMBLEM HEALTH PEREZINO ALGENDRO 20638160 No Certification required EMBLEM HEALTH LUKOWITS EMREN 20638159 No Certification required een EMBLEM HEALTH MACEN REN 20638163 No Certification required Save Requests EMBLEM HEALTH CALIDO KENNY 20638168 No Certification required to Database C Data Export C Show on screen C Print C Image File s Run with compliance check Wiew Request Start Responses Create Response File Wiew Report Move Processed File View EDI File No update available _ A file is loaded and the individual review requests listed in the grid Here we see the result of a request file loaded into the grid From here we can view and process the individual requests We have the choice to load the request data at the same time into the response lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 62 Manual Process Save Requests to Database f Mata Fwnnrt A check b
45. This evaluation version expires in 14 days lt 2013 gt Martin Scholl Consulting Inc NOS HIPAA Authorizer 10 2 10 2 1 10 2 2 Extending the trial by entering a license key Close the Registration Form and continue using the EDI Exchange Configuring EDI Exchange Obligatory Settings 1 Setting up Database Connection EDI Exchange work is based on the database connection that you define under Database Connection and Data Fields in the main menu of the HIPAA host application Make sure the connection has already been set up and tested before proceeding with EDI Exchange Then proceed to the next step Creating Database Tables 2 Creating Database Tables Once you have configured the database connection Setting up Database Connection follow the instructions below 1 Select EDI Exchange Create EDI Exchange Tables in the main menu Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information i A j i _ Pa A i dd a he Py The menu item to create the necessary tables lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 192 2 The Create Tables for EDI_Exchange screen will appear Table creation and or modification for your database is han
46. TracelD varchar 30 NULL TraceReference varchar 30 NULL RESPONSE ResponseType char 2 NULL CertificationAction char 2 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration ma CertificationNumber varchar 50 NULL DecisionReason varchar 30 NULL SecondSurgicalOpinion char 1 NULL IssueDate date NULL ExpirationDate date NULL EffectiveDate date NULL EffectiveEndDate date NULL ReferenceNumber varchar 50 NULL Patient_RejectReason1 char 2 NULL Patient_FollowUpCode1 char 1 NULL Patient_RejectReason2 char 2 NULL Patient_FollowUpCode2 char 1 NULL Patient_RejectReason3 char 2 NULL Patient_FollowUpCode3 char 1 NULL Patient_RejectReason4 char 2 NULL Patient_FollowUpCode4 char 1 NULL Patient_RejectReason5 char 2 NULL Patient_FollowUpCode5 char 1 NULL Patient_RejectReason6 char 2 NULL Patient_FollowUpCode6 char 1 NULL Patient_RejectReason7 char 2 NULL Patient_FollowUpCode7 char 1 NULL Patient_RejectReason8 char 2 NULL Patient_FollowUpCode8 char 1 NULL Patient_RejectReason9 char 2 NULL Patient_FollowUpCode9 char 1 NULL lt 2013 gt Martin Scholl Consulting Inc 115 HIPAA Authorizer LOINC_Code1 varchar 10 NULL LOINC_Code2 varchar 10 NULL LOINC_Code3 varchar 10 NULL LOINC_Code4 varchar
47. TransLog Table script 1 CREATE TABLE dbo TRANS_LOG ID varchar 200 NOT NULL Payload D varchar 200 NULL TRADING_PARTNER varchar 15 NULL TRANSACTION_TYPE char 3 NULL ORIG_TRANSACTION_TYPE char 3 NULL PROCESS_DATE date NULL PROCESS_TIME time 0 NULL OPERATOR varchar 20 NULL RECORD_IDS Vlad iy eS bi LD oo sJ E E a La Pa CHECK_DATE gt RN time 0 NULL CHECK_MESSAGES bigint NULL ResponseFile varchar 300 NULL AcknowledgementFile varchar 300 NULL ExitCode smallint NULL CONSTRAINT PK_TRANS_LOG PRIMARY KEY CLUSTERED ID ASC 22 ON PRIMARY 3 y lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 194 The Save button 6 For each script on every tab click Execute Script to create the corresponding table in the database coterie O Sie Microsoft SQL Server TRANS_LOG_ERRORS TradingPartner Table script 1 CREATE TABLE dbo TradingPartner TradingPartnerlD varchar 15 NOT NULL TradingPartnerID_QUAL char 2 NULL ETINNo varchar 15 NULL NAME varchar 40 NULL Contact varchar 100 NULL Phone varchar 15 NULL Extension varchar 101 NULL Email varchar 75 NULL Fax varchar 15 NULL LocalFtpUser varchar 20 NULL LocalFtpPassword varchar 20 NULL Address 1 varchar 100 NULL Address2 varchar 100 NULL City varchar 30 NULL State char 2
48. Type Sender ID ID Type Receiver ID Date Time Interchange ID Ack T P ISA 00 v 140929 1101 00501 272110145 v GS segment ST segment Sender Code Group Control Not Version Transaction ID 5010 ID GS HI 20140929 1101 X 005010X217 ST 278 005010X217 Creating 278 response records from the database Before you can start you have to enter values into the empty fields The HIPAA Authorizer will store most of the values for later use The next time you call up this screen it will be completed On top we see the query phrase Here you can enter any query that you want or you use the query builder discussed before and carry the query over into this screen Please be reasonable creating a file with many thousand records will take a few minutes lt 2013 gt Martin Scholl Consulting Inc 153 HIPAA Authorizer Then you need to decide whether you create a 278 request or a 278 response file One of the differences between request and response is the BHT_02 element It is 13 for the request and 11 for the response Request O Response The option to create a request or response file The next block is concerned with the ISA segment e Some values are filled in and shaded out These are created by the program Other fields are blank and you have to fill them out Once you filled them out the program will remember you last configuration and repeat it e SenderlD Type and Sender ID are your identifier You can select ZZ
49. ata Email Server Information e SMTP server e Sender s email address e SMTP server requires logon e Username e Password e Connect to the SMTP server via the SSL protocol e Use port E ee EDI Exchange Directory Setup Root Directory Path D EDI Email Server Information Email Notification SMTP Server Sender s email address F Send email notice of newly arrived Files smtp gmail com example gmail com Ada User Name Password Recipients SMTP server requires Logon user EPR 5 Connectto the SMTP server via the SSL protocol Use Port Outgoing Files Other options Validate outgoing files C Reject Incoming Files with more errors than set Count below Halt records if EDI compliance warnings are found EDI Riles with Other Type in Inbox Leave file for other program Auto process if other program is available Setting up the email server EDI Exchange is NOT yet initialized Note If you do not have this information please ask your administrator to set this portion up for you 4 To configure email notifications specify the following options Email Notification e Send email notice of newly arrived files Use this checkbox to define if you want to send email notice once new files have arrived e Recipients You can add your staff s email s and the processing messages will be sent to these emails Enter an email address and click Add lt 2013 gt
50. click menu Delete Request is highlighted You will be prompted before the record is deleted Delete Record Are you sure you want to delete record 2 Record deletion prompt After clicking Yes the record will be deleted from the Authorizer Header table and any related records will be deleted from the Authorizer Detail table This operation cannot be undone lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 60 3 Response Mode Viewing Requests 3 1 Loading Transactions from file In Response mode you typically open 278 Request files and load them into the application so that you can view and process them Selecting the EDI file The first step is to open a 278 record file Either do this with the gt File gt Open menu or by clicking on the File Open button in the tool bar 3 HIPAA Authorizer 64bit View Database Co Open Sample Files Open Directory New Request Select Printer Exit The Open File menu The Open File button is visible to the left of the menu on the tool bar ta HIPAA Authonzer 64bit File View Database a gt i i Maa Opening a file with the toolbar Once the file is opened you can process it by clicking on the Process button at the bottom of the information bar or by clicking the Run button on the tool bar lt 2013 gt Martin Scholl Consulting Inc et HIPAA Authorizer The Run button on the tool bar
51. first argument is the Query against the database Any query that works against the EDI_AuthorizerHeader table is permitted The relationship between header and detail table are handled internally by our program lt 2013 gt Martin Scholl Consulting Inc Automation 172 2 the word EDI indicating that we want to create an EDI file 3 The file name for the EDI file If this is blank default file naming convention or a trading partner s file naming convention will be used 4 If EDI Exchange is licensed and enabled you can specify here the trading partner who is the receiver of this electronic data interchange 5 The fifth argument decides whether a request or response is created The argument has to be either Response or Request if it is left out it will be a request For example C Program Files HIPAAsuite HIPAA AuthorizeriHIPAAAuthorizer exe Select from EDI_AuthorizerHeader where SubscriberlD 123456 EDI C temp test278 edi CAREFIRST Request this command would create an EDI file with all records from the query and write the file C temp test278 edi The trading partner to receive the file is CareFirst and a request file will be created C Program Files HIPAAsuite HIPAA Authorizer HIPAAAuthorizer exe Select from EDI_AuthorizerHeader where SubscriberlD 123456 EDI CAO Response This will create a response file for the California exchange Since no file name is specified the California
52. i Li a Database Microsoft SQL Sever Oracle MySQL Generic ImplementationAck Table script CREATE TABLE ImplementationAck ID int IDENTITY NOT NULL FileName varchar 100 NULL SenderlD varchar 15 NULL SendTime AA NULL GroupControlNo varchar 9 NULL TransactionControlNo varchar 9 NULL FuncitionallD char 2 NULL OnginalGroupControlNo varchar 9 NULL Version varchar 12 NULL AckCode char 1 NULL IncludedTS int NULL ReceivedTS int NULL AcceptedTS int NULL ErrorCode1 char 3 NULL ErrorCode2 char 3 NULL ErrorCode3 char 3 NULL ErrorCode4 char 3 NULL ErrorCode5 char 3 NULL PRIMARY KEY ID hd Compare Script with existing Table Save The Save button 6 For each script on every tab click Execute Script to create the corresponding table in the database lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 20 cone Toe roo ne 0 Sl Siete Database Microsoft SQL Sever Oracle MySQL Generic 1 CREATE TABLE SegmentErrors 2 ID int IDENTITY NOT NULL TS_1D int NOT NULL Ack_10 int NOT NULL SegmentlDCode char 3 NULL SegmentPosition int NULL Loop D varchar 4 NULL ErrorCode varchar 9 NULL PCTA CTX1_ContextName varchar 35 NULL CT X1_ContextReference varchar 35 NULL CTX1_SegmentlD char 3 NULL CTX1_Loop D varchar 4 NULL CTX1_SegmentPosition int NULL CTA1_ElementPosition int NULL
53. ideas was to make the EDI files as short as possible and to allow different languages to use the same descriptions by reducing long verbose explanations to 2 3 byte long codes Computer storage was incredibly expensive and making any file larger than it absolutely had to was considered wasteful The main menu of the HIPAA Authorizer has the item Code Sets Click on it and sub menus will lead you to the individual code sets that the HIPAA Authorizer uses The code sets are stored in the file codesets xml in the Configuration subdirectory of the Program Data section of the HIPAA Authorizer usually C ProgramData HIPAAsuite HIPAAClaimStatusResponder Configuration Codesets xml lt 2013 gt Martin Scholl Consulting Inc to HIPAA Authorizer EDI Exchange Log Help Facility Type UB Facility Types Follow Up Codes Gender Codes HI Codes ID Codes Level Of Service Level of Care Modifiers Nursing Home Status Oxygen Deliwery Oxygen Equipment Types Oxygen Finding Oxygen Test Condition Patient Condition Patient Location Patient Status Pattern Codes Prognosis Codes Provider Taxonomy Provider Type Selecting a Code Set for Display If you click on a code set menu the program will read all the specific codes and descriptions from the xml file CodeSets xml This file typically resides in C ProgramData HIPAAsuite HIPAAAuthorizer lt 2013 gt Martin Scholl
54. look at the complete screen we see a tabbed control on top with the subscriber and if different the patient information plus some diagnostic information Requester Info Patient Information Subscriber Relationship INS Subscriber is a patient Subscriber Name NM1 Last Name First SMITH JOE Employment Status AO Active Military Overseas Address N3 N4 Address PO BOXSUB 171021 TEST ADDRESS City State Zip KANSAS CITY MO Missouri 64108 Additional Identifiers REF ID Qualifier SY Social Security Number ID Type ID MI Member ID Number 12345678901 Demographic Information DRG DOB 03 22 1958 Sex M Male Health Information Accident Date 04 30 2005 Onset of Symptoms 04 15 2005 Event Date 05 16 2005 Admission Date 05 05 2005 Discharge Date 05 09 2005 Patent Event Level Provider Info Other UMO Service Event Level Country Code Subdivision Reject at Subscriber Level Last Menstrual 03 12 2005 Estimated Birth 11 30 2005 Diagnosis Type BF Diagnosis ICD 9 CM Diagnosis gt 141090 The subscriber screen Let s look first at the subscriber part Diagnosis Date cll inane lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 32 Relationship INS Subscriber Name NM41 Last Name First Middle Suffix Subscriber is a patient Employment Status ID Type D Address N3 N4 Address City State Zip Country Code Subdivision
55. mm warnings are found gt EDI Ales with Other Type in Inbox Leave file for other program Auto process if other program is available The EDI Exchange is successfully initialized message on the bottom of the EDI Exchange Setup window Troubleshooting Initialization lt 2013 gt Martin Scholl Consulting Inc 21 HIPAA Authorizer When you are going through the Initialization process of the EDI Exchange you can encounter the following message in the Processing Results window Checking for EDIDev EDIDev is not installed Processing Results EDI Exchange initalizaton started Checking SOL settings and tables Connection setings are checked Trading Partners table is checked TRANS_LOG table is checked TRANS_LOG_ERAODAS table is checked SEND_LOG table is checked COMPANY _SETUP table is checked COMPANY SETUP data is validated Checking tor Required Diractones Inbox Directory is checked Outbox Directory is checked Processed Directory is checked Crypt Directory is checked suspense Directory is checked Checking for EDIC FdiDev is not installed EDI Exchange encountered the above errors EDI Exchange is not operational until everything checks out The EdiDev component is not installed To resolve this issue do the following 1 Go to the http www edidev com ediregis htm site 2 Some systems may require Microsoft Redistributable Package to be installed first In this case
56. picture above The log entry for this command will be Set default company with ID 3 Company 3 is Set as a default company Excerpt from log Default company changed Running the application through the Windows Scheduler The HIPAA Authorizer can be automated through the Scheduler A scheduler is software that can be programmed to execute a certain task at a certain time repeatedly Windows has such a scheduler built in The Windows scheduler can be used to let the HIPAA Authorizer execute in regular intervals without user intervention Usually one would let the HIPAA Authorizer scan a directory and then print create image files or export the data and remove the files to prevent duplicate processing 1 If the task scheduler is installed on your system you will find it in the Control Panel lt 2013 gt Martin Scholl Consulting Inc Automation 174 To open Scheduled Tasks click Start Control Panel Scheduled Tasks Note In different Windows versions the way to access the Task Scheduler can differ Consult your Windows version documentation LES heduled Tasks 10 xj ee te fe tos eE ay sien Ff SE Other Places A Ge Control Panel Ey My Documents J My Network Places o AE 12 07 PM every o 12 07 00 PM The Windows Task Scheduler 2 Click on Add Scheduled Task and Scheduled Task Wizard will guide you through the setup process 3 In the first window read the w
57. s take a closer look at the functionality The first option says Loop 2000A System level Here we list rejection reasons on the highest the system level 42 Unable to Respond at Current Time 79 Invalid Participant Identification The rejection reasons on the system level When we check another option Loop 2010B Requester level for example then the options change lt 2013 gt Martin Scholl Consulting Inc NN HIPAA Authorizer E E 15 Required application data missing 35 Out of Network 41 Authorization Access Restriction 43 Invalid Missong Provider Identification 44 Invalid or Missing Provider Mame 45 Invalid Missing Provider Specialty 46 Invalid Missing Provider Phone Number 47 Invalid Missing Provider State 49 Provider is not Primary Care Physician 51 Provider is not on File T9 Invalid Participant Identification 97 Invalid or Missing Provider Addess The rejection reasons on the requester level For example a rejection of an out of network provider s authorization request would look like this gt gt Loop 20004 System Level Loop 20104 UMO Level Loop 20108 Requester Level A rejection of an out of network provider s authorization request When we save the request we see now in the work place grid that the request has been rejected The authorization status is set to Rejected The resultant EDI file will now contain a AAA segment in the 2010B loop with
58. sending a file to the Trading Partner notifying them that a file has been created for them e Reject Files with Compliance Errors This option will reject files that have compliance warnings and move them into the suspended files directory It also determines whether the TA1 and 999 indicate acceptance or the 999 lists all the errors and warning e Create a 277CA for 837 claims This option only applies to 837 Claims Checking this option will produce a 277CA Claims Acknowledgment report for received 837 Claim files e One ST SE loop per claim This option separates all claims into individual transactions enclosed by their own ST and SE segments Remote FTP Tab If your trading partner has an FTP Server then you can set up here the connection lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 230 information Read more in Using Built in FTP Client EDI Identifiers Options Remote FIP Contact Encryption Folders CORE a FIP Remote Connection and Directories F Differ Secure FIP FTP Address Download Server Explicit FTPS ftp_healinghospital com plicit FTPS User Name Implicit FTPS ie SFTP Password A User password Auth aa private Key Auth Port After Download 2l l Delete Fil Put Directory Get Directory Delete Files ici ins PickUp Move to Folder i Test Upload Connection Test Download Connection The Remote FTP tab The file transfer protocol FTP is one of the first int
59. so indicated in the Edit Mode setup Using the HIPAA compliance engine that is part of the optional EDI Exchange module a mock 278 transaction is created in memory and than tested with the compliance engine A window with the processing results will pop up lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 54 SEF file HIPAAAuthorizer SEP_Hiles 278_005010X 21 Review SemRefSEP loaded fi No Warnings The window with the compliance check results Once a request is saved without warnings a green check mark appears in the last column of the work place request grid 32450079 This careful procedure guarantees that requests made with the HIPAA Authorizer are valid and that they should be accepted by the receiving party lt 2013 gt Martin Scholl Consulting Inc 55 HIPAA Authorizer 2 11 Viewing a request Once the request is saved to the database or loaded from an EDI file we can view the request form by selecting it and clicking the View button or the View Request option in the right click menu HIPAA Preview Health Care Services Request for Review Trading Partner ID SUBMITTERS ID Document Date 12 31 1999 3 02 AM Transaction ID 200300114000001 Transaction Purpose Request Request 2 UMO UMO Name ABC PAYER Electronic Transmitter Identification Number ETIM 123450000 Requester Provider Name GARDENER JAMES Federal Employer ID 000012345 Provider UPIN Numbe
60. stored in the EDI_AuthorizerDetail table If no detail information is present then there will be no record in this table The service detail in loop 2000F of the 278 transaction can transmit a variety of information segments When you click on the Service Detail tab in the main tab control you will see the following screen lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 48 Requester Info Subscriber Patient Patient Event Level Provider Info Other UMO Service Event Level Review Inf A a a Health Care Services Review Information Request Category Certification Type service Type Bill Type Facility Type Service Date Previous Certification ID H Date Previous Administrative Reference ID Period Trace Numbers Trace Number Entity ID Additional Entity ID Save Service Details The Service Detail screen This first tab Review Info looks very similar to the Review tab on the patient event level and indeed the information goes to an UM segment But this information is not required Put only UM information into this screen if it differs from the information given in the loop 2000E In addition to the UM segment we also have fields for a proposed service data or date range that will go into a DIP segment as well as certification IDs that we transmit in REF segments In the bottom of the screen is a grid Here are all the service details listed Note that unless you click on
61. this lt 2013 gt Martin Scholl Consulting Inc Responding to Requests 92 information 9 NM1 1P 1 GARDENER J AMES 24 860012345 10 REF 16 123456 11 REF 1 223457 12 AAA N 35 N 13 PRWCO PXC 203B50133X The EDI file with the AAA segment informing the requester about the rejection reason If we again load the request for editing we see now that it has been processed This important information is also saved in the database Response Type 15 No further updates to Follow Request Has Been Processed On 12 02 2014 At 3 54 PM By Martin 4 2 Creating the Response After carefully reviewing the request we can now respond to the request by clicking the Adjudicate Request button in the bottom of the response screen Response Type 16 No further updates to Follow ll Adjudicate Request Reject Request The Adjudicate Request button The following screen will show up ad Response to 278 Request of Review and Authorization Certification Action Code Certification Number Reject Reason Second Surgical Opinion Required Xx E E Additional information Certification Issue Date Certification Expiration Date Logical Observation IDs Af E Af E Certification Effective Date from __ _j lr Period Administrative Reference Number 1433660626 lt 2013 gt Martin Scholl Consulting Inc 93 HIPAA Authorizer 4 3 The screen to compose the response to the request Approval M
62. this trouble there is the button Compare Script with existing Table you click this the table structure in your database will be compared with the script There are two possible outcomes Your table is up to date You have all the fields in your table There is nothing to do Table is up to date or if your table is missing recently added fields you will see a window pop up that shows an Alter Table script with which you can add those fields to the table without interfering with existing data lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 196 oJ Changes to your table Alter Table TradingPartner Add SourceEntitylD char 2 NULL SourcelDQualfer char 2 NULL SourceName varchar 50 NULL SourcelD varchar 50 NULL 2 5 6 The Alter Table script that shows as a result of missing fields You can now click the Execute Script button and the field will be added and a message will confirm your changes Alter Table statement successfully executed Once you have created the tables you can start setting up the other application options See the next step Defining Auto Processing Options 10 2 3 2b Creating 999 File Tables Once you have configured the database connection Setting up Database Connection follow the instructions below 1 Select EDI Exchange Create 999 Files Tables in the main menu lt 2013 gt Martin Scholl Consulting Inc 197 HI
63. 1 To access the list of available SEF Files select SEF Files under the EDI Exchange menu lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 264 EDI Exchange Check EDI File Trading Partners ae Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The SEF Files menu item 2 The SEF Files window will appear all SEF Files Available Standard Exchange For 624 005010422041 SemRefSEF 634 A095 SEF 6354 X09541 SemRefsEF 997 4010 SEF 999 005010X23141 SEF A list of SEF files lt 2013 gt Martin Scholl Consulting Inc HIPAAsuite RealTime Client 266 11 HiPAAsuite RealTime Client 11 1 Concepts 2 The HIPAAsuite RealTime Client is a communications client designed to interact with SOAP and MIME services This makes HIPAA Authorizer able to request and receive EDI files in turn enabling providers of health care services to check whether a patient is covered by a health insurance policy electronically The client will package and send EDI 278 files and receive the 278 response transaction files using secure http as a transport medium The RealTime Client is also capable of sending unencrypted test only messages for use in a testing environment however in a production env
64. 10 NULL LOINC_Code5 varchar 10 NULL LOINC_Code6 varchar 10 NULL LOINC_Code7 varchar 10 NULL LOINC_Code8 varchar 10 NULL LOINC_Code9 varchar 10 NULL LOINC_Code10 varchar 10 NULL LOINC_Code11 varchar 10 NULL LOINC_Code12 varchar 10 NULL ResponseFileName varchar 100 NULL ResponseUser varchar 40 NULL ResponseFileDate date NULL ResponseFileTime char 10 NULL UM RequestCategory char 2 NULL CertificationT ype char 1 NULL ServiceType varchar 2 NULL FacilityT ype varchar 2 NULL FacilityCode varchar 2 NULL RelatedCause1 varchar 3 NULL RelatedCause2 varchar 3 NULL RelatedCause3 varchar 3 NULL AccidentState char 2 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration ne AccidentCountry varchar 3 NULL ServiceLevel varchar 3 NULL ConditionCode char 1 NULL PrognosisCode char 1 NULL ReleaseOf InformationCode char 1 NULL DelayReasonCode varchar 2 NULL REF PreviousCertification varchar 30 NULL PreviousAdminCertification varchar 30 NULL DTP AccidentDate date NULL LastMenstrualDate date NULL EstimatedDateofBirth date NULL OnsetDate date NULL EventDate date NULL AdmissionDate date NULL DischargeDate date NULL HI Diagnosis AdmitDiagnosisCodeType char 3 NULL AdmitDiagnosisCode varchar 35
65. 13 gt Martin Scholl Consulting Inc 135 HIPAA Authorizer Provider1ID varchar 30 NULL Provider1OtherlDQual1 varchar 3 NULL Provider10OtherlD1 varchar 30 NULL Provider1OtherlDDesc1 varchar 80 NULL Provider10OtherlDQuaBl varchar 3 NULL Provider10OtherlD2 varchar 30 NULL Provider1OtherlDDesc2 varchar 80 NULL Provider1OtherlDQualB varchar 3 NULL Provider10OtherlD3 varchar 30 NULL Provider1OtherlDDesc3 varchar 80 NULL Provider1Address1 varchar 30 NULL Provider1Address2 varchar 30 NULL Provider1City varchar 25 NULL Provider1State char 2 NULL Provider1Zip varchar 10 NULL Provider1Contact varchar 60 NULL Provider1Telefone varchar 20 NULL Provider1Extension varchar 10 NULL Provider1Fax varchar 20 NULL Provider1Email varchar 60 NULL Provider1URL varchar 100 NULL Provider1TypeCode char 2 NULL Provider1 Taxonomy varchar 30 NULL Provider1_RejectReason1 char 2 NULL Provider1_FollowUpCode1 char 1 NULL Provider1_RejectReason2 char 2 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 136 Provider1_FollowUpCode2 char 1 NULL Provider1_RejectReason3 char 2 NULL Provider1_FollowUpCode3 char 1 NULL Provider1_RejectReason4 char 2 NULL Provider1_FollowUpCode4 char 1 NULL Provider1_RejectReason5 char 2 NULL Provider1_Follow
66. 13 gt Martin Scholl Consulting Inc Responding to Requests 96 e Use a context menu that appears on right clicking the editor and search replace and use standard text functions such as cut copy and paste IU PERFIC Jo0an 1E 20655 p 11 PRV PC ZZ 203BI0300Y 12 HL 3 7 22 1 13 DTP 431 D8 20020425 14 HPBK 599 0 D3 20020501 15 NM1 IL 1 DOE JOHN P MI 11122333301 16 REF 6P 599119 17 DMG D8 19400816 M 18 HL 4 3 19 1 19 MM1 1T 1 FAWCETTE JOHNATHAN Q 20 REF 1G C073845 21 N3 806 ST VINCENTIUS DRIVE SUITE 500 22 N4 BELLINGHAM WA 95487 23 PER IC TE 2065551214 24 PRV PE ZZ 246ZV0500N Select All 25 HL 5 4 s9 0 26 TRN 1 176 1630932323 27 UM SC l 73 11 A y Find 28 PWIC 11 BM AC Doe 5 1 02 UTest Urinalysis Te 29 5E 27 000000176 30 GE 1 176 31 IEA 1 00000017 Figure 2 The context menu for the EDI Editor that pops up on right clicking the editor window lt 2013 gt Martin Scholl Consulting Inc Database Integration MOS 5 Database Integration 5 1 Overview The HIPAA Authorizer can export authorization request records into any ODBC or OleDB compliant database Exchanges with Microsoft SQL Server mySQL and IBM AS400 have been successfully demonstrated The HIPAA Authorizer uses two tables EDI_AuthorizerHeader and EDI_AuthorizerDetails into which the 278 data are exported These tables can also serve as staging tables for the integration with
67. 15 NM1 IL 1 DOE JOHN P MI 11122333301 16 REF 6P 599119 17 DMG D8 19400816 M 18 HL 4 3 19 1 19 NM1 1T 1 FAWCETTE JOHNATHAN Q 20 REF 1G C73845 21 M3 806 ST VINCENTIUS DRIVE SUITE 500 22 N4 BELL INGHAM WA 95487 23 PER IC TE 2065551214 24 PRV PE ZZ 246ZVO500N 25 HL 5 4 SS 0 26 TRN 1 176 1630932323 27 UM SC 1I 73 11 ARO Y 28 PWK 11 BM AC Doe 5 1 02 UTest Urinalysis Test 29 SE 27 000000176 30 GE 1 176 31 IEA 1 000000176 32 The EDI Editor When you right click anywhere in the text a floating menu will appear with typical test edit options such as cut copy and paste lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer 22 12 N4 ANYTOWN MD 2 1299 13 REF 1C 895465 14 HL 2 22 0 15 SBR P 18 MB 16 NMT IL 1 Nosmith Herman MI 654621234A 1 N3 10 Sth Avenue 18 N4 Nanachut MD 13747 19 DMG D8 19201225 M 20 MIMIPPR2S lt 0YZ Carrier Services Inc P8395675 21 CLM 765992 65 11 1 Y A2Y9 C 22 HI BK 2749 23 NIM1 82 1 Wellmaker John 34 987121234 24 PRV PE ZZ 203BF0100Y 25 REF 1G A54321 Select All 26 DEI 27 SV1 HC 99213 65 UN 1 N 28 DIP 472 D8 20010315 Find 99 REF 6R C1 30 HL 3 1 22 0 31 SBR P 13 B E A E Mona Replace The floating menu of the EDI editor right click anywhere in the text to make it appear Typing Ctrl F brings of the text search utility ST 337 0001 5 Bnnio Find what Direction E
68. 2 Adjusting Image Options From the menu Image you can reach the Image Options screen Image Viewer w Image File Options The Image Menu and the following screen comes up Image Files Outpu Path For Image Files Y Image Format Image folder options TIFF Format PDF Format None Color On Images Red Black Image File Options All images in one File with EDI File Name as Image File Name O Sub Folders for Year Month and Day W Sub Folders for Year and Week Options for PDF O One Image File per Record Options for TIFF Color Depth Black White O 4 bpp s 24 bpp 32 bpp Setting up the image file options Sub Folders for Year and Day E Use conte Horizontal resolution 200 dpi Y Vertical Resolution Horisontal Resolution Vertical resolution 200 dpi You can configure the following options e Set the directory where image files will be saved e Set image file and folder options e Determine image format Y lt 2013 gt Martin Scholl Consulting Inc Creating Image Files and PDF s 162 e Determine options for PDF and TIFF files e Determine the document background color for images Read the detailed descriptions further 3 Once you have finished editing the options click Save The settings are saved to the Windows registry and will be retained for the next time you run the program Check your permissions to write to the regi
69. 2008 and above e Oracle e MySQL Note In case your database is not listed modify the scripts or ask your database administrator to make the necessary modifications 1 The following tables are part of EDI Exchange e ImplementationAck SQL statements to create the ImplementationAck table in your database This table contains information about Acknowledgments e TransactionResponse SQL statements to create the TransactionResponse table in your database This table contains individual transactions contained in 999 files lt 2013 gt Martin Scholl Consulting Inc 199 HIPAA Authorizer e SegmentErrors SQL statements to create the SegmentErrors table in your database This table contains individual segments in error contained in 999 transactions e ElementNotes SQL statements to create the ElementNotes table in your database The table contains the elements in error in a specific segment 5 You can modify the scripts so that they run on your specific database Once you have you modified the script click Save Tip Every database system has their own little syntax idiosyncrasies and the scripts might require tweaking You can edit the table scripts in this screen and save your modified scripts One example are date and time or money data types that do not exist in SQL Server 2005 You can just rename those types to datetime and save you script and it will run fine ont
70. 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer SJ Service Provider HARDESTY DAVID Q SJ Service Provider HARDESTY2 DAVID2 Q SS Provider Type Provider Information Last Name HARDESTY First Name DAVID Middle Name Provider Type 5J Service Provider ID Type XX National Provider Identifier ID 1234567893 Paperwork Msc ID Type Provider ID zA National Provider ldentfier 1234567893 XX National Provider Identifier Address State Zip Phone URL The service line level provider screen Extension Reject at Service Provider Level We can reject the service line on the provider level When we click on the Reject at the Service Provider Level we have the reject form come up with the following reasons to choose from 15 Required application data missing 33 Input Errors 35 Out of Network 41 Authorization Access Restriction 43 Invalid Missong Provider Identification 44 Invalid or Missing Provider Name 45 Invalid Missing Provider Specialty 46 Invalid Missing Provider Phone Number 47 Invalid Missing Provider State 49 Provider is not Primary Care Physician 57 Provider is not on File 52 Service Dates Not Within Provider Plan Enrollm 79 Invalid Participant Identification 97 Invalid or Missing Provider Addess IP Inappropriate Provider Role The list of reject reasons on the service provider level lt 2013 gt Martin Scholl Con
71. 3OtherlD2 varchar 30 NULL Provider3OtherlDDesc2 varchar 80 NULL Provider3OtherlDQualB varchar 3 NULL lt 2013 gt Martin Scholl Consulting Inc 139 HIPAA Authorizer Provider3OtherlD3 varchar 30 NULL Provider3OtherlDDesc3 varchar 80 NULL Provider3Address1 varchar 30 NULL Provider3Address2 varchar 30 NULL Provider3City varchar 25 NULL Provider3State char 2 NULL Provider3Zip varchar 10 NULL Provider3Contact varchar 60 NULL Provider3Telefone varchar 20 NULL Provider3Extension varchar 10 NULL Provider3Fax varchar 20 NULL Provider3Email varchar 60 NULL Provider3URL varchar 100 NULL Provider3TypeCode char 2 NULL Provider3Taxonomy varchar 30 NULL Provider3_RejectReason1 char 2 NULL Provider3_FollowUpCode1 char 1 NULL Provider3_RejectReason2 char 2 NULL Provider3_FollowUpCode2 char 1 NULL Provider3_RejectReason3 char 2 NULL Provider3_FollowUpCode3 char 1 NULL Provider3_RejectReason4 char 2 NULL Provider3_FollowUpCode4 char 1 NULL Provider3_RejectReason5 char 2 NULL Provider3_FollowUpCode5 char 1 NULL Provider3_RejectReason6 char 2 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 140 Provider3_FollowUpCode6 char 1 NULL Provider3_RejectReason7 char 2 NULL Provider3_FollowUpCode7 char 1 NULL
72. 51 Multiple Procedures Unit Charge Amount Diagnosis Pointers EPSDT Indicator UN Unit 240 00 Y Yes Nursing Home Level of Care The professional service line information The information in this screen is very similar to a claim line in the CMS 1500 form 3 8 3 Institutional Procedures Service procedures that fall under the institutional claim type UB 04 as form have their lt 2013 gt Martin Scholl Consulting Inc es HIPAA Authorizer place in the Institutional tab institutional Dental Delivery Paperwork Msg Provider Revenue Code ProcedureCode Type 120 AD428 HC HCPCS Code Procedure Description Modifiers 1 through 4 50 Bilateral Procedure 51 Multiple Procedures Quantity Unit Rate Charge Amount Nursing Home Status Nursing Home Level of Care The information in this screen is equivalent to a claim line in the UB 04 form 3 8 4 Dental Procedures Authorization requests for dental procedures are displayed in the Dental tab Professional institutional Delivery Paperork Msg Provider Procedure Code Type D2150 Procedure Description AD American Dental Association Codes Quantity Charge Amount Oral Cavity Designation Code 1 550 00 01 o2 o 4 Prosthesis Crown or Inlay Code Reason for Replacement Initial Placement lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 84 Th
73. 7115001285 40290 ot Postion 3 DESCRIP TION No data in mandate Waming in Line 29 gt NMI7217 3001285740290 at Position 3 DESCRIPTION No data in mandate Warning in Line 29 gt NM17721001285740290 al Postion 4 DESCRIP TION No data in mandate Waming in Line 37 gt SBR P Group Name 738510 at Position 9 DESCRIPTION Value 98910 not f Warning in Line 37 gt SER Group Name 98910 at Position 9 DESCRIPTION Maamnum length of Waring in Line 41 gt DMG DS 19990 06 F RS E2 at Position 5 DESCRIPTION Non composte datas Waming in Line 41 gt DMG D 719330706 F R5 E2 at Position 5 D Load Date Load Time Operator E 0 Records from to fe 310747539 TEST_EBMC p_ 501054 O 41147417 top 0208p Details of the EDI Receive Log If the records have been exported to the database you can see the time date and record count Accessing EDI Send Log This page contains instructions on how to access the EDI Send Log window It becomes available once EDI Exchange has been initialized 1 Select EDI Send Log under the EDI Exchange menu lt 2013 gt Martin Scholl Consulting Inc Waming in Line 21 gt CLM A371H556 3025 0013 4 1 at Position DESCRIPTION Mo data in mand Find Log Files EDI Exchange 262 EDI Exchange Check EDI File Trading Partners ae Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Crea
74. 9 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information Run p Run with A menu item to request a license key 2 Once you have clicked this menu item your default email application appears In our case it is Microsoft Outlook All information necessary to produce the key is automatically filled out From Martin Scholl HIPAAsuite com Ce l Bee Subject EDI Exchange SDCFEBF Request for License Request for License Product EDI Exchange Volume ID 78DCFSBF Current Key Key 19th spe e e ae ii Email message created by EDI Exchange 3 You can add a trial extension or a final key after purchasing or relocating the lt 2013 gt Martin Scholl Consulting Inc EDI Exchange software Once you receive the response with the key for EDI Exchange you can bring the Registration Form screen up again and click on Register Enter the key to unlock EDI Exchange In the Result area you will see that EDI Exchange has been registered Registration Form Result Thank you for evaluating Exchange ED Exchange is fully functional with certain trial limitations This evaluation version expires in 14 days Entering the license key 10 1 3 Registering EDI Exchange EDI Exchange is licensed separately from the host applicat
75. AAClaimPaymentMaster Run at user logon At user logon Never d eee Se HIP AAEnrollmentMaster Run at user logori Ak user logori Newer E Shared Documents Md My Network Places The Windows Task Scheduler 9 Enter parameters to the Run field after the application path and click OK Refer to Using the Command Line Arguments CLI for more information Example C Program Files HIPAAsuite HIPAA Authorizer HIPAAAuthorizer exe C EDI Inbox X HIPAAEnrollmentMaster Task Schedule Settings EA C AWINDOWS Tacks HIPAAEnrolimenth aster job Rur f ent basten HIPAAE rolimentM aster exe CXAEDPInbos A Start inc C Program Fles HIFA Asut HIPAA Enrollment Master Run as user Set password F Run only flogged on he Enabled scheduled task rune at specified time The HIPAAAuthorizer task window You can see the path to the executable is in quotes and then the arguments follow In this example the directory c EDI Inbox Will be processed The X option indicates that the data will be exported to the database lt 2013 gt Martin Scholl Consulting Inc 179 HIPAA Authorizer Tip Logs may be helpful when running the program automatically through the scheduler See Application Log Tip When running the HIPAA Authorizer through automation either through the scheduler or through shell call from other programs it is important to remove processed files to prevent them from running again I
76. CTX1_ComponentDataElementPos int NULL CTX1_RepeatingDataElementPos int NULL CTX1_ElementReference1 varchar 4 NULL CTA1_ElementReference varchar 4 NULL CTX2_ContextName varchar 35 NULL CTX2_ContextReference varchar 35 NULL CTX2_SegmentlD char 3 NULL CT X2_LooplD varchar 4 NULL Compare Script with existing Table Execute Script The Execute Sc ript button Notice Creating tables means clicking the Execute Script button in all four tabs of the Create Tables for 999 Files window Then close this window 7 Once the table has been created successfully you will see the following notification The Create Table sc ript success message Warning Double execution of a script wipes out the previous table you have created A prompt will warn you before deleting an existing table To Add Remove fields use the Compare Script button Remove the script files once you have created the tables so nobody can destroy the tables by accident lt 2013 gt Martin Scholl Consulting Inc 201 HIPAA Authorizer Caution The double execution warning message Make sure there are no error messages and the table creation has been completed successfully Compare Script with existing Table HIPAAsuite products go through continual development and improvements Often these changes lead to new fields in the database While it is easy to drop a table and regenerate it with the new fields you wil
77. Code Subdivision Contact Information PER Contact Email Provider Information PRV Provider Code Specialty Additional Identifiers REF ID Qualifier ID Type ID Code The new request screen This screen is structured according to the 278 implementation guide Each screen represents a loop or segment of the EDI file The 278 transaction is after the 837 the most complex of the HIPAA EDI transaction sets The reason is that it serves many medical specialties with disparate needs The level 2000A the Utilization Management Organization UMO level is the receiver of this request message and represented by the destination trading partner and managed in the trading partner screen We therefore have no screen for it here lt 2013 gt Martin Scholl Consulting Inc 20 HIPAA Authorizer 2 3 Requester screen The Requester Info screen contains the information of loop 2010B This loop consists of an Name or NM1 segment The first two lines in the form the address information N3 and N4 segments Contact information PER segment provider specialty PRV segment and additional provider identifiers REF segments Once filled out the Requester information can be saved to the database for future reuse Requesting Physician Last Organization Name First Name Middle Name Suffix Entity Type D Type ID Address City State Zip Country Code Subdivision Provider Code specialty Contact Phone Extension Fax
78. Code3 varchar 2 NULL ResponseReportID3 varchar 80 NULL ResponseReportDescription3 varchar 80 NULL MSG Message varchar 264 NULL Provider 1 Provider1EntitylD char 2 NULL Provider1Name varchar 60 NULL Provider1FirstName varchar 35 NULL Provider1MiddleName varchar 25 NULL Provider1Suffix varchar 10 NULL Provider1IDQual char 2 NULL Provider1ID varchar 30 NULL Provider1OtherlDQual1 varchar 3 NULL Provider10OtherlD1 varchar 30 NULL Provider1OtherlDDesc1 varchar 80 NULL lt 2013 gt Martin Scholl Consulting Inc 123 HIPAA Authorizer Provider10OtherlDQuaBl varchar 3 NULL Provider10OtherlD2 varchar 30 NULL Provider1OtherlDDesc2 varchar 80 NULL Provider1OtherlDQualB varchar 3 NULL Provider1OtherlD3 varchar 30 NULL Provider1OtherlDDesc3 varchar 80 NULL Provider1Address1 varchar 55 NULL Provider1Address2 varchar 55 NULL Provider1City varchar 25 NULL Provider1State char 2 NULL Provider1 Zip varchar 10 NULL Provider1Contact varchar 60 NULL Provider1Telefone varchar 20 NULL Provider1Extension varchar 10 NULL Provider1Fax varchar 20 NULL Provider1Email varchar 60 NULL Provider1URL varchar 100 NULL Provider1TypeCode char 2 NULL Provider1 Taxonomy varchar 30 NULL Provider1_RejectReason1 char 2 NULL Provider1_FollowUpCode1 char
79. Consulting Inc The HIPAA Authorizer 20 Record Count 7 ae Code Description gt BE No special conditions for Test At rest at room air Walking N Nospecial conditions forTest gt gt Z On ye RA ama S Sleepina MR A O A A Viewing a Code Set You can add alter and delete codes 1 9 The EDI Editor Under the menu item View you have the option EDI Editor plus you have the EDI icon on the toolbar to invoke the EDI Editor EDI files are often hard to read especially if they have no carriage returns and line feeds to put each segment on a line of its own When you have no file open than the file dialog box opens and you can navigate to the file that you wish to see When you have a file already opened and you click this menu option the editor will open and the following screen will appear lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer aL File sheguest ec File Edit View Help MS 240 006 1 ISA 00 gg ZZ MMEDOOOS ZZ 00510BC 920501 1037 U 00401 000000176 0 T 2 GS H I MMEDO003 00510BC 20020501 1037 176 X 004010X094A1 3 ST 278 000000176 4 BHT 0078 13 176 20020501 1037 5 HL 1 26 1 6 NM1 X3 2 Great Benefit Plan pI 842610001 7 HL 2 1 21 1 8 NM1 1P 1 WELBY MARCUS J J r 24 097654322 9 REF 1G G64536 10 PER IC Joan TE 2065551212 FX 2065551213 11 PRV PC ZZ 203BI0300Y 12 HL 3 2 22 1 13 DTP 431 D8 20020425 14 HI BK 599 0 D8 20020501
80. DenialReason3 varchar 50 NULL lt 2013 gt Martin Scholl Consulting Inc 129 HIPAA Authorizer OtherUMO3DenialDate date NULL Additional Patient Info Contact ContactName varchar 60 NULL ContactFirstName varchar 35 NULL ContactMiddleName varchar 25 NULL ContactSuffix varchar 10 NULL ContactIDQual char 2 NULL ContactID varchar 30 NULL ContactAddress1 varchar 55 NULL ContactAddress2 varchar 55 NULL ContactCity varchar 25 NULL ContactState char 2 NULL ContactZip varchar 10 NULL Contact varchar 60 NULL ContactPhone varchar 20 NULL ContactExtension varchar 10 NULL ContactFax varchar 20 NULL ContactEmail varchar 60 NULL CONSTRAINT PK_edi_AuthorizerHeader PRIMARY KEY CLUSTERED Id ASC WITH PAD_INDEX OFF STATISTICS NORECOMPUTE OFF IGNORE_DUP_KEY OFF ALLOW_ROW_LOCKS ON ALLOW_PAGE_LOCKS ON ON PRIMARY ON PRIMARY CREATE TABLE edi_AuthorizerDetails Detailld bigint IDENTITY 1 1 NOT NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 130 Headerld bigint NULL TRN TraceOriginator varchar 30 NULL TracelD varchar 30 NULL TraceReference varchar 30 NULL UM RequestCategory char 2 NULL CertificationT ype char 1 NULL ServiceType varchar 2 NULL FacilityT ype varchar 2 NULL Bill ype char 1 NULL REF
81. EDI Exchange 186 e EDI Control for Transactions The EDI protocols have a few supporting transaction sets that are useful to the smooth functioning of EDI exchanges They provide the sender with an instant feedback on receipt The following transaction sets are available e TA1 Acknowledgment e 997 999 Functional Acknowledgment e 277U 277CA Unsolicited Claim Status Response in case of Claims e Logging EDI Exchange has several logs that are instrumental to keep processing in order and allows to forensically investigate mishaps There are three logs in EDI Exchange e Incoming file log See Accessing EDI Receive Log e Outgoing file log See Accessing EDI Send Log e Daily transaction log 10 1 2 Requesting EDI Exchange License If your trial has expired you can request an extension to the trial If you purchased the product and need a final license key you should request an EDI Exchange license Follow the instructions below to request a trial or final license key 1 Select Request EDI Exchange license under the EDI Exchange menu item lt 2013 gt Martin Scholl Consulting Inc 187 HIPAA Authorizer EDI Exchange Help Check EDI File File View Database CodeSets Image Setup Log ao a Trading Partners Output Mode Inbox Manager Y Screen FTP Client 5 Printer SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 99
82. Email varchar 60 NULL Provider2URL varchar 100 NULL Provider2TypeCode char 2 NULL Provider2Taxonomy varchar 30 NULL Provider2_RejectReason1 char 2 NULL Provider2_FollowUpCode1 char 1 NULL Provider2_RejectReason2 char 2 NULL Provider2_FollowUpCode2 char 1 NULL Provider2_RejectReason3 char 2 NULL Provider2_FollowUpCode3 char 1 NULL Provider2_RejectReason4 char 2 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 138 Provider2_FollowUpCode4 char 1 NULL Provider2_RejectReason5 char 2 NULL Provider2_FollowUpCode5 char 1 NULL Provider2_RejectReason6 char 2 NULL Provider2_FollowUpCode6 char 1 NULL Provider2_RejectReason7 char 2 NULL Provider2_FollowUpCode7 char 1 NULL Provider2_RejectReason8 char 2 NULL Provider2_FollowUpCode8 char 1 NULL Provider2_RejectReason9 char 2 NULL Provider2_FollowUpCode9 char 1 NULL Provider 3 Provider3EntitylD char 2 NULL Provider3Name varchar 35 NULL Provider3FirstName varchar 25 NULL Provider3MiddleName varchar 10 NULL Provider3Suffix varchar 10 NULL Provider3IDQual char 2 NULL Provider3ID varchar 30 NULL Provider30ther DQual1 varchar 3 NULL Provider3OtherlD1 varchar 30 NULL Provider3OtherlDDesc1 varchar 80 NULL Provider30ther DQual2 varchar 3 NULL Provider
83. Exchange s specific file naming convention will be implemented 8 5 Changing the Default Company The default company is the identity you assume as the sender when creating EDI files This affects the ISA GS and NM1 sender segments A single entity may have a need to act as multiple sender identities and so has a need to change the information in the EDI envelopes The default company can be changed using command line arguments affecting the ISA and GS sender ID segments 154 Segment Sender Identifier HIPAA SUITE Qualifier Mutually Defined a Application Senders Code GS 2 HIPAASUITE1 5 Tax ID 9876543210 A rl aro imi CE lt 2013 gt Martin Scholl Consulting Inc 173 8 6 HIPAA Authorizer Sender ID segments in Company Setup To change the default company a single argument is needed Setcompany followed by the company ID of the company you wish to set setcompany lt ID gt The Companys ID in this case is not its EDI identifier but the value of the ID row in the COMPANY_SETUP table It can also be found in the Company Setup window Current Company PAI y Y Default company 1 TESTRESPONDER HIPAASUITE 3 HIPAASUITE Add company Company selection in Company Setup Example The command argument setcompany 3 C o Program Files HIPAAsuite HIPAA Authorizer gt HI PAAAUthorizer setcompany 3 will set the default company to ID 3 which is HIPAASUITE2 in the example
84. FE315 D02D23E12DB8CAD3SABCB9226399D4A0 Ownertrust unknown Stored on this computer Photo Actions At the moment Kleopatra does not support photos Trust Certifications made by this Certificate in certificates lt has no support for adding nor for displaying them This is for the following reasons Photos give a false sense of security Photos increase the size of certificates Certificate details with Kleopatra lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 252 10 6 Using EDI Exchange Features 10 6 1 Accessing Inbox Manager Using the Inbox Manager you can access the most important functions of EDI Exchange Inbox Manager allows you to download EDI files into the Inbox folder and process these files This screen handles the post processing of the EDI files their compliance check and auto processing options 1 To access the Inbox Manager click the Inbox Manager under the EDI Exchange menu EDI Exchange Help Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Inbox Manager menu item 2 The following screen will come up lt 2013 gt Martin Scholl Consulting Inc 253 HIPAA Authorizer 10 6 2
85. HIPAA Authorizer 1 1 Introduction The HIPAA Authorizer is HIPAAsuite s application for the X12 278 transactions These transactions are concerned with authorizations and utilization and service review of healthcare services Often insurance contracts require the provider to obtain an authorization for the procedure they are about to undertake Mostly done over the phone or some voice response system the HIPAA act of 1996 envisioned that this process can be handled by machines and the communication should be done according to the X12 specification Authorizations are notoriously complex Every specialty of medicine has its peculiarities and special information segments and all these have to be properly captured so that the request can be adjudicated This makes the 278 transaction potentially very complicated Unique to this transaction is that it contains two separate transactions the creation of the request and the response to a request are listed in the same transaction set The HIPAA Authorizer handles both modes With the HIPAA Authorizer one can manually create the most detailed electronic authorization requests and send them to the trading partner as well as study the requests in detail and create the responses and transmit them back to the originating requester There are several cases where the HIPAA Authorizer can be utilized HIPAA Authorizer for Payers A payer can conduct all the Authorization and Services Review related e business inc
86. Here are two frames with such information lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 44 Functional Limitations The above conditions Apply Do not Apply Permitted Activities The above conditions Apply Do not Apply Functional Limitations and Permitted Activities The top frame lists functional limitation that will go into a CRC segment with the qualifier 75 the bottom frame list activities that the patient is permitted to do and form the segment CRC 76 2 6 8 Mental Status Another list of conditions that can afflict a patient are mental conditions For the authorization of mental health services it is important to convey the mental status of a patient The following screen does that lt 2013 gt Martin Scholl Consulting Inc as HIPAA Authorizer 2 6 9 Mental Status Information The above conditions gt Apply O Do not Apply Mental Status information Mental Status Information is represented in the CRC 77 segment You can choose from 5 different mental status that either apply or no apply Home Health Services The last tab on the specialty review level is home health This tab lists conditions and procedures that are administered at home and not at the office Services range from a temporary rehabilitation to hospice care for terminally ill patients Home Health Care Information Prognosis Home Health Start Date jf j E Certification Type Medical Procedur
87. ITTERS ID is not set up File 278_5010_Request ed processed at 9 29 2014 9 06 15 AM Number of Claims in File 1 The Trading Partner with the ID 12456789012345 is not set up File 273_5010_Response ed processed at 9 29 2014 9 42 44 AM Number of Claims in File 1 Processing of the file 278_5010_Response edi began at 9 29 2014 11 37 17 AM Records Images will be created Processing ended at 9 29 2014 11 37 24 AM The file D Temp 278 Response Files 2014 September 29 273_5010_Response pdf has been created The Trading Partner with the ID 12456789012345 is not set up Another instance of the program is running Aborting at 9 29 2014 12 00 43 PM Another instance of the program is running Aborting at 9 29 2014 12 03 01 PM The Transaction Log window File Processing with EDI Exchange If you have the EDI Exchange enabled the command line arguments change If you are processing incoming files then you can put all new files in the Inbox subdirectory of your EDI file root Now by using the single command line argument Auto you will process every file in this inbox according to the setting you selected in the EDI Exchange gt Auto Process Setup If you want to process a specific file instead of the Inbox directory you can use the file name as a second argument File Creation Creating 278 EDI files can also be automated with the HIPAA Authorizer The necessary command line arguments are as follows 1 The
88. Match case Up 8 Down 17 PER IC Jane Doe TE 9005555555 18 HLT 172270 The search utility Ctrl H will bring up the replace utility lt 2013 gt Martin Scholl Consulting Inc 23 HIPAA Authorizer a IT A l Find what NON Find Next Replace with Replace al E Match case Cancel inne 4 a i a Th Be tah A h gt of 7 BPEJ AE j E na q I 47 rs AA rt Po 4 E w ls eas SWZ 20 SUN 43 DTP 472 D8 19970114 50 NTE ADD 3071 NONPPO THROUGH CONCENTRA PREFFERED SYSTEMS Es E s The Find and Replace utility If you make changes to the file the Save button becomes enabled and you can save any changes The HIPAA Authorizer will further on work with those changed files you don t have to open the file again Changing EDI files can be a tricky undertaking You should be experienced in the format of the 278 and understand that an 278 claim file could be a legal document that should not be altered without the consent of the originator lt 2013 gt Martin Scholl Consulting Inc 25 HIPAA Authorizer 2 Creating Authorization Requests 2 1 Request Mode The HIPAA Authorizer has two modes Request Mode and Response Mode serving the two manifestations of the 278 transaction We can select the Request mode in two ways 1 When the program starts we click on the image of the begging requester Request Authorization 2 We select t
89. MySQL and Oracle If you have other databases you might have to modify the scripts to conform to the specific database s syntax This screen allows you to edit save and run the table scripts Watch any error messages to make sure that the table creation is successful lt 2013 gt Martin Scholl Consulting Inc Database Integration 142 Create SQL Tables Database Microsoft SQL Server MySQL Authorizer Header Authorizer Details COMPANY_SETUP EDL AuthorizerDetail Table script 1 CREATE TABLE edi_AuthorizerDetails DetailId bigint IDENTITY 1 1 NOT NULL HeaderId bigint NULL TRN TraceOriginator varchar 30 NULL TraceID varchar 30 NULL TraceReference varchar 3 NULL UM RequestCategory char 2 NULL CertificationTypel char 1 NULL ServiceType varcharl 2 NULL FacilityTypel varchar 2 NULL BillType char 1 NULL REF PreviousCertification varchar 30 NULL PreviousAdminCertification varchar 36 NULL DTP ServiceDate date NULL ServiceEndDate date NULL CertificationAction char 2 NULL CertificationNumber varchar 56 NULL DecisionReason varchar 30 NULL SecondSurgicalOpinion char 1 NULL IssueDatel date NULL ExplrationDatel date NULL EffectiveDate date NULL cffartiuwnlnAnatal Aan N Compare Script with existing Table 60 y ou fa Lu ha Ar Pu ow oul Js Lu Pb Po wW Po Pi Bo
90. NM1 IL 1 SMITH JOE MI 12345678901 15 REF SY 123456789 16 N3 PO BoxSub 171021 TEST ADDRESS2 17 N4 KANSAS CITY MO 64108 18 DMG D8 19580322 M 19 INS Y 18 AQ 20 HL 4 3 23 1 21 NM1 QC 1 SMITH MARY 22 REF EJ 321456789 23 N3 PO Box 171021 TEST ADDRESS2 24 N4 KANSAS CITY M0 64108 25 DMG D8 19880322 F File Edit View Help 28 TRN 1 2001042801 9012345678 CARDIOLOGY 29 UM SC I 3 11 A 30 HCR A1 23132145 31 REF NT 1433660628 32 REF BB A123 33 DTP 439 D8 20050430 34 DTP 484 D8 20050312 35 DTP ABC D8 20051130 36 DTP 431 D8 20050415 37 DIP AAH D8 20050516 38 DTP 435 D8 20050505 39 DTP 096 D8 20050509 40 HI BF 41090 D8 20050415 41 HSD VS 1 DA 1 7 10 42 CL1 3 43 CRI T 44 CR2 1 5 AS CRS se DASS oooO te oko JH A 46 CR6 7 20050429 y T 47 MSG This is a free form text message 48 NM1 SJI 1 WATSON SUSAN 34 98 765432 1 49 REF 1G 12345 50 N3 77 HOLLY BLVD SECOND PART 51 M4 KANSAS CITY MO 64108 52 PER IC M TUCKER TE 8189993456 FX 8188769304 53 PRV PE PXC 203BS0133X 54 NM1 SI 1 WATSON2 SUSAN2 34 987654321 55 REF 1G 123452 56 M3 727 HOLLY BLVD SECOND PART 57 N4 KANSAS CITY2 M0 64108 58 PER IC M TUCKER TE 8189993456 FX 8188769304 59 PRV PE PXC 203BS0133X 60 NM1 PW 2 PATIENT DIALYSIS CENT AA AE AAA TA A Displaying the 278 response file This window allows you to e view the EDI file e Change the raw EDI file and save it lt 20
91. P Desktop Pretty Good Privacy PGP is a data encryption and decryption computer program that provides cryptographic privacy and authentication for data communication PGP is often used for signing encrypting and decrypting texts e mails files directories and whole disk partitions to increase the security of e mail communications PGP and similar products follow the OpenPGP standard RFC 4880 for encrypting and decrypting data For more information see How PGP works EDI Exchange supports PGP encryption and works seamlessly with PGP Desktop and open source Gpg4Win applications PGP Desktop Symantec s encryption solutions is a comprehensive suite of encryption applications which provides flexible multi layered encryption by bundling Drive Encryption to secure the files stored on local hard drives and Desktop Email Encryption to secure confidential data in email For more information see PGP Desktop documentation PGP Desktop key features 1 Hard drive encryption software locks down the entire contents of a laptop desktop external drive or USB flash drive including boot sectors system and swap files 2 Enables encrypted email and secure AIM Instant Messages 3 Creates storage independent encrypted containers for transport and sharing of specific files using included utilities PGP Self Decrypting Archive PGP Virtual Disk and PGP Zip 4 Includes PGP Shredder which can completely destroy unwanted disk based files a
92. PAA Authorizer EDI Exchange Check EDI File Trading Partners ae Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create ED Exchange Tables Create 999 Files Tables aT Autoprocess Setup F Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information z 3 pi e aw a eS SS The menu item to create the necessary tables 2 The Create Tables for 999 Files screen will appear Table creation and or modification for your database is handled here lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 198 cer II O Database Microsoft SQL Server Oracle MySQL Generic CREATE TABLE ImplementationAck ID int IDENTITY NOT NULL FileName varchar 100 NULL SenderlD varchar 15 NULL SendTime datetime NULL GroupControlNo varchar 9 NULL TransactionControlNo varchar 9 NULL FuncitionallD char 2 NULL OnginalGroupControlNo varchar 9 NULL Version varchar 12 NULL AckCode char 1 NULL IncludedTS int NULL RecemvedTS int NULL AcceptedTS int NULL Errorfode1 char 3 NULL ErrorCode char 3 NULL ErrorCode3 char 3 NULL ErrorCode4 char 3 NULL ErrorCode5 char 3 NULL PRIMARY KEY ID Compare Script with existing Table The eereew create able 3 Select the database type you use for your host HIPAA application e Database e Microsoft SQL Server SQL Server
93. PM Application 316 KB d a EP psftp exe 8 6 20136 12PM Application 328 KE a EP putty chm 8 6 2013 6 12PM Compiled HTML 438 KE wd putty cnt 8 6 2013 6 12PM CNT File 32 KB di Orca EP putty exe 8 6 2013 6 12PM Application 484 KB di Par putty hlp 8 6 20136 12PM Help file 644 KB de puly E puttygen exe 8 6 2013 6 12 PM Application 180 KB 4 pein ee E README bt 1 23 2007 12 38 PM Text Document 2 KB b E a unins000 dat 12 30 2013 12 30 GOM Media file d 4 KB al ae E unins000 exe 12 30 2013 12 30 Application 705 KE eee li website 11 16 2004 11 14 Internet Shortcut 1 KB Je Samsung The programs and files that come with putty One of the programs is puttygen exe This program creates the necessary keys When you start it up you can generate a key pair lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 24a E PuTTY Key Generator a File Key Conversions Help Key Public key for pasting into OpenSSH authonzed_ keys file ssh4sa de AAAABSNzal TycZEAAAABIOAAAQEAgISLnBOIKMGIIOFPSysh5SCPhile TINENzoDH E ud TuLocearZV E DrTr2Tvg3u5xC1nJ8DLpaDericAkdU bdWCtp TRS mnf xs WE V3 Basa Rgwt Rv TCm OHm ghulaGrMRWPjin4kb5CFp0VeP nWhRAH Taz 6u AmA E0HGtgSuhiKOkIJJFHE Key fingerprint eshasa 4048 69 00 3 48 93 90 02 33 39 2b 0a b1 cc 12 cd a3 Key comment rsakey 40131230 Key passphrase e Confirm passphrase sessseset Actions Generate a public private key pair Load an existing private key file Par
94. Paper Work Report Type Transmission Control Number Description E bl The Additional Patient Information tab Lastly at the bottom of the screen are dates relevant to the request and a grid for diagnostic codes Health Information Accident Date Onset of Symptoms Event Date Admission Date Discharge Date Last Menstrual Estimated Birth HAI Br _ fj B _j B _j r B _j fj _ Diagnosis Type Diagnosis Diagnosis Date F Health Information at the bottom of the Subscriber screen The dates speak for themselves the diagnosis codes need more explanation At the time of this writing January 2014 the US health system is transitioning from ICD 9 to ICD 10 codes To clearly mark codes the first field in the diagnosis grid has a pull down menu to select the diagnosis code type lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 34 Diagnosis Type ABF Diagnosis ICD 10 CM ABJ Admitting Diagnosis ICD 10 CM ABK Principal Diagnosis ICD 10 CM APR Patients Reason for Visit ICD 10 C BF Diagnosis ICD 9 CM Save gJ Admitting Diagnosis ICD 9 CM BK Principal Diagnosis ICD 9 CM PA DR Diagnosis Related Group PR Patients Reason for Visit ICD 9 CM The different diagnosis code types to choose from 2 5 Subscriber Patient Auto complete As with the requester the program can keep track of previously entered persons and recall them for time saving data en
95. PreviousCertification varchar 30 NULL PreviousAdminCertification varchar 30 NULL DTP ServiceDate date NULL ServiceEndDate date NULL RESPONSE CertificationAction char 2 NULL CertificationNumber varchar 50 NULL DecisionReason varchar 30 NULL SecondSurgicalOpinion char 1 NULL IssueDate date NULL ExpirationDate date NULL EffectiveDate date NULL EffectiveEndDate date NULL lt 2013 gt Martin Scholl Consulting Inc 131 HIPAA Authorizer ReferenceNumber varchar 50 NULL RejectReason1 char 2 NULL FollowUpCode1 char 1 NULL RejectReason2 char 2 NULL FollowUpCode2 char 1 NULL RejectReason3 char 2 NULL FollowUpCode3 char 1 NULL RejectReason4 char 2 NULL FollowUpCode4 char 1 NULL RejectReason5 char 2 NULL FollowUpCode5 char 1 NULL RejectReason6 char 2 NULL FollowUpCode6 char 1 NULL RejectReason7 char 2 NULL FollowUpCode7 char 1 NULL RejectReason8 char 2 NULL FollowUpCode8 char 1 NULL RejectReason9 char 2 NULL FollowUpCode9 char 1 NULL LOINC_Code1 varchar 10 NULL LOINC_Code2 varchar 10 NULL LOINC_Code3 varchar 10 NULL LOINC_Code4 varchar 10 NULL LOINC_Code5 varchar 10 NULL LOINC_Code 6 varchar 10 NULL LOINC_Code7 varchar 10 NULL lt 2013 gt Martin Scholl Consulting
96. Protocol which is XML based and increasingly used in the communication between disparate computer systems HIPAAsuite supports both protocols You can set up a trading partner s transaction delivery mechanism to either MIME and SOAP and thus instantly send a request and receive the answer within 20 seconds EDI Exchange is required for this feature EDI Exchange EDI Exchange is a module that all HIPAAsuite application can share It deals with the management of trading partner relationships EDI transport encryption and logging of received and sent files Application Setup Under the main menu item Setup we find the item Application Setup When we click this the following screen comes up File View Database CodeSets Image Setup EDI Exchange Log Hel Ez e Application Setup Com pa ny Set up Edit Mode Setup ae Delimiters Setup Cil The Application Setup menu lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer 12 Application Setup Indicates Mandatory Fields Response files Directory to write Response Files HAHIPAAsuite HIPAAsuiteCommDir Outbox Processed Files 0 Leave in Place Directory to move Processed Files Move HAHIPAAsurte HIPAAsuiteCommbDinProcessedF iles 0 Delete Log Document Color Processed and gt om Response Files Folders iW Keep a log of every file processed On Screen On Paper Read Wy ha A nE Red Red Exchange Setup Black
97. Qual1 7 Modifiers EDI AuthorizerDetails Seane Screen W RequestorOtherlD1 Wi ProcedureDescription z _ W RequestorOtheriDQual2 i Amount V RequestorOtherID2 unit Save Response into Database Save Connection Information Test Configuration Save Field Configuration lt 2013 gt Martin Scholl Consulting Inc Database Integration 102 The connection and field configuration screen The right side of the form defines the connection while the left side defines the fields to be exported Here the Connection setup Connection Properties Database Type Database Server Name ASQLExpress Test Connection Database hipaasuite W Checked Username Password Authorizer Header Table Name EDI AuthorizerHeader You can create the Authorizer Detail Table Name fables through a rough a PRE be separate screen EDI AuthorizerDetails Save Response into Database Save Connection Information Defining the connection parameters e Database Type Microsoft SQL Server either with its own authentication or Windows authentication ODBC ODBC for Oracle or Oracle Direct Connect e Database Server Name or DSN In case of SQL server this is the IP adress or the name of the database server for ODBC this is the Data Source Name DSN that is defined through the ODBC setup in the Control Panel of Windows e Database This is the database under the above connection e Username
98. ULL HSD HSDQuantityQualifier char 2 NULL HSDQuantity bigint NULL HSDUnitCode char 2 NULL HSDSampleModulus varchar 6 NULL HSDTimePeriodQualifier varchar 2 NULL HSDPeriodCount int NULL HSDServicePatternCode varchar 2 NULL HSDTimePatternCode char 1 NULL CRC ConditionCodeCategory1 char 2 NULL ConditionCodelndicator1 char 1 NULL ConditionCode1_1 char 2 NULL ConditionCode1_2 char 2 NULL ConditionCode1_3 char 2 NULL ConditionCode1_4 char 2 NULL ConditionCode1_5 char 2 NULL ConditionCodeCategory2 char 2 NULL ConditionCodelndicator2 char 1 NULL ConditionCode2_1 char 2 NULL ConditionCode2_2 char 2 NULL lt 2013 gt Martin Scholl Consulting Inc ma HIPAA Authorizer ConditionCode2_3 char 2 NULL ConditionCode2_4 char 2 NULL ConditionCode2_5 char 2 NULL CL1 AdmissionTypeCode char 1 NULL AdmissionSourceCode char 1 NULL PatientStatus varchar 2 NULL NursingHomeStatus char 1 NULL CR1 Ambulance Certification WeightUnit char 2 NULL PatientWeight numeric 18 2 NULL AmbulanceTransport char 1 NULL AmbulanceReason char 1 NULL DistanceUnit char 2 NULL TransportDistance numeric 18 2 NULL TransportFrom varchar 55 NULL TransportTo varchar 55 NULL TripPurposeDescription varchar 80 NULL StretcherPurposeDescription varchar
99. UMO Service Event Level Requesting Physician Requester Name NM1 Last Organization Name First Name Middle Name GARDENER JAMES Entity Type ID Type ID 1P Provider 24 Federal Employer ID 000012345 Address N3 N4 Address 43 SUNRISE BLVD City State Zip Country Code Subdivision KANSAS CITY MO Missouri 64106 Contact Information PER Contact Phone Extension Fax WILBER 818 999 1234 818 676 9304 Email Provider Information PRV Provider Code Specialty CO Consulting 203B50133X Additional Identifiers REF ID Qualifier ID Type 16 Provider UPIN Number J Facility ID Number ID Code Response Type 15 No further updates to Follow h Adjudicate Request Reject Request The screens to study the request and create the response As the screens were already explained in detail in the chapter on Request Mode we don t go through them again but concentrate on the response specific sections Here we see the requester tab And on the bottom we see a combo box where we can select the response type and two buttons Adjudicate Request and Reject Request In order to understand the meaning of these buttons we have to look at the two types of responses that the 278 can convey The normal adjudication response will indicate if the authorization is given or not and why not The rejection will cite a reason why the request was not valid Maybe the subscriber is unknown maybe the requester not in the sys
100. UpCode5 char 1 NULL Provider1_RejectReason6 char 2 NULL Provider1_FollowUpCode6 char 1 NULL Provider1_RejectReason7 char 2 NULL Provider1_FollowUpCode7 char 1 NULL Provider1_RejectReason8 char 2 NULL Provider1_FollowUpCode8 char 1 NULL Provider1_RejectReason9 char 2 NULL Provider1_FollowUpCode9 char 1 NULL Provider 2 Provider2EntitylD char 2 NULL Provider2Name varchar 35 NULL Provider2FirstName varchar 25 NULL Provider2MiddleName varchar 10 NULL Provider2Suffix varchar 10 NULL Provider2IDQual char 2 NULL Provider21D varchar 30 NULL Provider2OtherlDQual1 varchar 3 NULL Provider20OtherlD1 varchar 30 NULL Provider2OtherlDDesc1 varchar 80 NULL lt 2013 gt Martin Scholl Consulting Inc 137 HIPAA Authorizer Provider2Other IDQual2 varchar 3 NULL Provider2Other lD2 varchar 30 NULL Provider2OtherlDDesc2 varchar 80 NULL Provider2OtherlDQualB varchar 3 NULL Provider2Other lD3 varchar 30 NULL Provider2OtherlDDesc3 varchar 80 NULL Provider2Address1 varchar 30 NULL Provider2Address2 varchar 30 NULL Provider2City varchar 25 NULL Provider2State char 2 NULL Provider2Zip varchar 10 NULL Provider2Contact varchar 60 NULL Provider2Telefone varchar 20 NULL Provider2Extension varchar 10 NULL Provider2Fax varchar 20 NULL Provider2
101. a request Once the request is saved to the database or loaded from an EDI file we can edit the request by selecting it and clicking the Edit Request button or selecting Edit Request option after right clicking the request The same screen that is used to manually enter a request will be shown filled with the selected request record s information If edited and saved the record will be modified to reflect the changes al Edit Request Requesting Physician Requester Name NM1 Last Organization Name First Name Middle Name GARDENER JAMES Entity Type D Type ID 1P Provider 24 Federal Employer ID 000012345 Address N3 N4 Address 43 SUNRISE BLVD SUITE 234 City state Zip Country Code Subdivision KANSAS CITY MO Missouri 64106 Contact Information PER Contact Phone Extension Fax WILBER 818 999 1234 818 876 9304 Email Provider Information PRV Provider Code Specialty CO Consulting 203BS0133X Additional Identifiers REF ID Qualifier ID Type 16 Provider UPIN Number 1J Facility ID Numbe as Facility ID Number Delete Save Requester into Database Save Close The screens to view and edit the request 2 13 Sending a request to a trading partner Once the request is saved and all compliance check errors and warnings have been successfully dealt with we can send the request to its destination For this we highlight one or m
102. act AMYLOU HARRIS Email Phone Extension Fax 206 555 1212 Ed a Additional Identifiers ID Qualifier ID Code ID Type 16 Provider UPIN Number 189UP 7732 ID Code El Employer s Identification Nu 524478594 Save Requester into Database Turning Auto complete On or Off Under Setup is the menu Edit Mode Setup Here you have two check boxes in the middle that determine whether you will have auto complete in name fields and or ID fields lt 2013 gt Martin Scholl Consulting Inc 147 HIPAA Authorizer E Turn off Auto Con plete for Requester Subscriber and Provider names E Turn off Auto C mplete for Requester Subscriber and Provider ID s Create and Edit Requests Check requests on compliance while saving The Edit Mode Setup screen lt 2013 gt Martin Scholl Consulting Inc 149 HIPAA Authorizer 6 Working with stored requests 6 1 Stored Requests Once the requests records are stored in the database they can be accessed from the program Under Database gt Store Authorization Requests EA HIPAA Authorizer 64bit CodeSets Image Setup EL Connection and Data Fields Table Creation Fields Mapping Stored Authorization Records Stored Requesters Stored Patients Stored Providers Create EDI Authorizations Manual F Getting to the stored request records The following screen will come up Here are all the records in the database listed lt 2013 gt
103. ading Partners Output Mode Screen Inbox Manager FTP Client alos SEF Files Spreadsheet File ASCII File EDI Exchange Setup Encryption Setup Image File AS Create EDI Exchange Tables i Create 999 Files Tables C Data Export Autoprocess Setup i Automatic Scheduler EDI Recenve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The EDI Exchange menu in HIPAA Enrollment Master EDI Exchange performs the following functions lt 2013 gt Martin Scholl Consulting Inc 185 HIPAA Authorizer Trading Partners Management The following Trading Partner s parameters can be stored and transparently managed with the help of EDI Exchange name address EDI identifiers delivery methods encryption parameters FTP servers CORE Compliant server addresses and credentials communication numbers and folders to keep files separated special requirements specific to this trading partner Read more in Setting up Trading Partners File Transport EDI Exchange has a built in FTP client that can securely connect to your trading partner s FTP servers If you employ your own FTP server you can utilize the folder structure that EDI Exchange uses to manage incoming files users home directories and permissions so that your Trading Partners can drop off and pick up EDI files Supported are e Simple FTP e FTP Secure e Implicit FTPS e Explicit FTPS e Secure Shell FTP or sFTP
104. agePeriod 4 ReceiverName 4 ReceiverlD lt 2013 gt Martin Scholl Consulting Inc Database Integration 106 The fields in error are now unchecked 5 6 SQL Table scripts Below are the scripts for Microsoft SQL Server If you have a different database you wil have to slighty alter the scnpts Both tables have an ID column that is self incrementing The field HeaderlD in the child table is the foreign key and points to the ID in the header table CREATE TABLE edi_AuthorizerHeader Id bigint IDENTITY 1 1 NOT NULL TradingPartnerlD char 15 NULL TradingPartnerlDQual char 2 NULL FileDate date NULL FileTime char 10 NULL FileName varchar 100 NULL ProcessDate date NULL ProcessTime char 10 NULL Status tinyint NULL Version char 12 NULL TransactionID varchar 30 NULL Purpose char 2 NULL UMOName varchar 35 NULL UMOIDQual char 2 NULL UMOID varchar 30 NULL UMOContact varchar 60 NULL UMOPhone varchar 20 NULL UMOExtension varchar 10 NULL UMOFax varchar 20 NULL lt 2013 gt Martin Scholl Consulting Inc 107 HIPAA Authorizer UMOEmail varchar 60 NULL UMOURL varchar 100 NULL UMO_RequestValid1 char 1 NULL UMO_RejectReason1 char 2 NULL UMO_FollowUpCode1 char 1 NULL UMO_RequestValid2 char 1 NULL UMO_RejectReason2 char 2 NULL UMO_FollowUpCode2 char 1 NULL
105. alls the HIPAA Authorizer s executable and gives a folder path as first argument and specifies database export x as second argument C Program Files HIPAAsuite HIPAA Authorizer HIPAAAuthorizer exe C Inbox EDI X EN Administrator C Windows system32 cmd exe C Program Files HIPAAsuite HIPAA Authorizer gt HlPAA uthorizer exe GiNInboxS EDI A C o Program Files HIPAAsuite HIPAA Authorizer gt Example 1 command entered to the Command Prompt Example 2 This example issues a SQL query and gives the file name for the 278 file Select from EDI_AuthorizerHeader where SubscriberFirstname Frank EDI C Temp file 278 lt 2013 gt Martin Scholl Consulting Inc 169 HIPAA Authorizer EN Administrator C Windows system32 cmd exe C Program Files HIPAAsuite HIPAA Authorizer gt HIPAAAUthoFizer exe EDI G Select a EDI_AuthorizerHeader where SubscriberFirstname Frank EDI C Tempsfile 2 CG 5 Program Files HIPAAsuite HIPAA Authorizer gt Example 2 command entered to the Command Prompt Using Command Prompt Follow the instructions below to use the command line arguments in Windows Command Prompt 1 Start a Windows Command Prompt Go to Start Programs Accessories Command Prompt Alternatively you can go to Start Run type cmd without quotes and press lt Enter gt 2 Type your command and click Enter lt 2013 gt Martin Scholl Consulting Inc Automation
106. alth Spinal Manipulation Service Information Treatment Series Treatment Count Subluxation Level Subluxation Level Code Il E Nature of Condition Complication Indicator Are X Rays available T Patient Condition Description Patient Condition Description ll Chiropractic Certification Information The above conditions Apply Do not Apply The Chiropractor screen In the upper part is information for the CR2 segment which list subluxation levels and and conditions The lower part has more condition codes that go into the CRC 08 segment 2 6 5 Durable Medical Equipment Durable Medical Equipment DME such as hospital beds wheel chairs and such need their own justification and authorization For this purpose we have a CRC segment with the qualifier 09 lt 2013 gt Martin Scholl Consulting Inc NN HIPAA Authorizer Review Delivery Ambulance Chiropractor DME Oxygen Activities Limitations Mental Status Home Health Durable Medical Equipment Conditions The above conditions Apply O Do not Apply Durable Medical Equipment screen This information forms the CRC 09 segment and help justify the expense of durable medical equipment such as wheelchairs 2 6 6 Oxygen Therapy Oxygen Therapy is most of the time done at home Patients with severe breathing problems and diminished lung function are equipped with oxygen bottles or generating equipment The screen consists of two parts the first part list
107. ameters Type of key to generate 0 SSH 1 RSA SSH 2 RSA SSH 2 DSA Number of bits in a generated key 2048 Creating a public private key pair with puttygen You can save the public and private keys separately as ppk files but that is not what we Import key Export OpenSSH key Export ssh com key u3 TuLS Lao l m r Tr Tvgsu5XC InJ DLpaDer cAkd Ukip TRXmntg gt tab Conversions Om toa VPin FAA GC EnfiWaP AirWvhRH Tai Converting the SSH key into a pem certificate When we click on Export OptnSSH key we can then save the key with an pem ending and that is it lt 2013 gt Martin Scholl Consulting Inc 245 HIPAA Authorizer 10 5 10 5 1 10 5 2 Using Encryption About Encrytion EDI Exchange supports the Private Key Infrastructure PKI encryption method This type of encryption is the most generally accepted method of protecting EDI Files from being pried upon by unauthorized persons Without going further into the details of PKI Public key encryption is a cryptographic technique which enables users to securely communicate on an insecure public network and reliably verify the identity of a user via digital signatures Read more in Private Key Infrastructure A public key infrastructure PKI is a system for the creation storage and distribution of digital certificates which are used to verify that a particular public key belongs to a certain entity The PKI creat
108. ameters for a Trading Partner on the Encryption tab EDI Identifiers Options Remote FTP Contact Folders CORE Encryption Setup Asymetrical Encryption 0 Private Key Infrastructure PGP Key email address of key owner No Encryption The Encryption tab Encryption Setup e Asymmetrical Encryption e Private Key Infrastructure PGP Key email address of key owner e No Encryption Folders Tab Within the HIPAAsuite Communications Directory each Trading Partner has his own folder This keeps files finely separated and in order Here is where you can set this up Read more in Defining Communications Directory lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 234 EDI identiers Options Remote FTP Contact Encrypion Folders core Local Directory Settings Outgoing Files Root Trading Partner s Outbox o DAED Outbox TXEBS Processed Files Root Trading Partner s Repository DAEDNProcessedFiles TXEBS i File Naming Convention Create Folders Using Trading Partner ID CMS The Folders tab e Outgoing Files Root This field has a pre generated path You can change this path by changing the EDI Root Directory e Trading Partner s Outbox Mandatory setting Click on the three dots button to access the Select Folder window There you choose an existing folder or create a new one e Processed Files Root This field has a pre genera
109. ample gmail com User Name Password SMTP server requires Logon user HA C Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than set Count below E Halt records if EDI compliance warnings are found B D EDI Exchange ts NOT yet initialized The Reject incoming files with more errors than option 5 Click on Save ana Email Notification C Send email notice of newly arrived Files Recipients example email com EDI Ales with Other Type in Inbox Leave file for other program Auto process if other program is available ee A E EDI Exchange Directory Setup Root Directory Path DED SMTP Server Sender s email address smtp gmail com example gmail com ESE Password SMTP server requires Logon user a E Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than 2 A set Count below C Halt records if EDI compliance warnings are found U D EDI Exchange ts NOT yet initialized 10 3 3 Running the Application via Scheduler O Send email notice of newly arrived Files Recipients example email com EDI Files with Other Type in Inbox 9 Leave file for other program Auto process if other program is available EDI Exchange integrates with the Windows Scheduler to allow the automation of the EDI file exchange process You can set up EDI Exchange to go out to the tradin
110. as several features that enhance its capabilities and can be licensed individually When you click under the Help the menu item Features and Licenses E kh Help Documentation k s View Manual About Check For Updates Project History Report an Issue Ctrl I De Identify Utility Features and Licenses h nrima ee The Features and Licenses menu You will see the following form come up Features and Licenses x HIPAA Authorizer Key LG hO MOYO0 TR Aras 27 vy 4 o JAF bsb P MiZ Enter License Key Product Features Request License Image Creation f On C Off Licensed M Work with Database On C Off Licensed MW RealTime Client On C Off Licensed MW EDI Exchange Key UT o1 S0BU0 DZMBC boEW4 1P 1 BlZ Enter EDI Exchange Key SAVE Registration Number FoFORBRSE lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer to The Features and Licenses form Basic Version The basic version of the HIPAA Authorizer has is capable in request mode to o Create 278 authorization requests o To load and read 278 authorization responses in response mode to o Load 278 requests o Create 278 response This basic mode is quite limited but allows at a low cost to perform the most important task of the HIPAA Authorizer Image Creation The image creation feature allows to save the images of requests and responses into PDF or TIFF files See the chapter on image file creation Database Conn
111. ate sub directories required to operate ED Exchange Directory Setup Root Directory Path The root communications directory setup 4 Click Save RootDirectoryPath D EDI Browse Email Server Information Email Notification SMTP Server Sender s email address O Send email notice of newly arrived Files Add User Name Password O SMTP server requires Logon Recipients C Connectto the SMTP server via the SSL protocol Use Port Outgoing Ales Other options O Validate outgoing files C Reject Incoming Files with more errors than set Count below Halt records if EDI compliance warnings are found O ED Ales with Other Type in Inbox EDI Exchange is NOT initialized Initialize EDI Exchange i panned Ra Leave file for other program sm perce ope pone ete The Save button After setting the root directory you can click the Initialize EDI Exchange button Read more in Initializing EDI Exchange 10 2 6 5 Initializing EDI Exchange Before you can use EDI Exchange and after you have configured the obligatory settings you have to perform the initialization Follow the instructions below 1 Select EDI Exchange Setup under the EDI Exchange menu item lt 2013 gt Martin Scholl Consulting Inc 207 HIPAA Authorizer Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoproces
112. ation and permitted activities screen serves just this purpose Here are two frames with such information lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer Functional Limitations 02 Patient was bed confined before the ambulance service The above conditions Apply Do not Apply Permitted Activities 10 Patient is ambulatory The above conditions a Apply Do not Apply Functional Limitations and Permitted Activities The top frame lists functional limitation that will go into a CRC segment with the qualifier 75 the bottom frame list activities that the patient is permitted to do and form the segment CRC 76 3 5 8 Mental Status Another list of conditions that can afflict a patient are mental conditions For the authorization of mental health services it is important to convey the mental status of a patient The following screen does that lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 76 Review Delivery Ambulance Chiropractor DME Oxygen Activiies Limitaions Mental Status Home Health Mental Status Information 07 Patient had to be physically restrained The above conditions Apply Do not Apply Mental Status information Mental Status Information is represented in the CRC 77 segment You can choose from 5 different mental status that either apply or no apply 3 5 9 Home Health The last tab on the specialty review level is home
113. atory data element 66 ir Warning in Line 11 gt NM1 85 2 KEY HEALTH DEMO at Position 9 DESCRIPTION No data in mandatory data element 67 ir Warning in Line 14 gt REF 1 at Position 2 DESCRIPTION No data in mandatory data element 127 in Data Segment REF J COEL Warning in Line 14 gt REF 1J at Position 2 DESCRIPTION Conditional data element missing Element 127 Position 2 CODE Warning in Line 14 gt REF 1 at Position 3 DESCRIPTION Conditional data element missing Element 352 Position 3 CODE Warning in Line 14 gt REF 1J DESCRIPTION The REQUIRED rule syntax for data segment REF has been violated At least one of Warning in Line 14 gt REF 1J DESCRIPTION Conditional syntax check failed for segment REF Buffer REF 1J _ CODE 12459 Warning in Line 15 gt PER IC TE at Position 2 DESCRIPTION No data in mandatory data element 93 in Data Segment PER J C Warning in Line 15 gt PER IC TE at Position 4 DESCRIPTION No data in mandatory data element 364 in Data Segment PER Warning in Line 15 gt PER IC TE at Position 4 DESCRIPTION Conditional data element missing Element 364 Position 4 C Warning in Line 15 gt PER IC TE DESCRIPTION The PAIRED rule syntax for data segment PER has been violated All of the datz Warning in Line 15 gt PER IC TE DESCRIPTION Conditional syntax check failed for segment PER Buffer PER IC TE
114. ber HIN e 27 Carrier ID Number Identification Number as assigned by HCFA e 28 Fiscal Intermediary ID Number Identification Number as assigned by HCFA e 29 Medicare Provider and Supplier ID Number Identification Number as assigned by HCFA e 30 U S Federal Tax ID Number Identification Number e 33 NAIC Company Code National Association of Insurance Commissioners Company Code e ZZ Mutually Defined e Application Sender s Code GS_2 The option represents the program or machine that created the file Usually the same as the ISA Segment Sender Identification lt 2013 gt Martin Scholl Consulting Inc 15 HIPAA Authorizer You can select other ID if you need Obligatory option The GS_02 identifier is usually the same as the ISA identifier but you can also choose some other ID lt represents the program or machine that created the file but the most common is a repetition of the ISA identifier e Tax ID Obligatory option Also called an Employer Identification Number EIN e Plan ID Payor ID Fill in your Payer ID and Plan ID if you have one this is only important for the 271 and 277 transactions Optional setting e Three letter identifier to prepend to all outgoing EDI files Optional setting Makes your files easily identifiable e Entity Type Code This code is only required for the 276 277 transaction in the STC_01 3 element EDI version Specify EDI version e onl
115. berZip varchar 15 NULL SubscriberCountry varchar 3 NULL SubscriberSubdivision varchar 3 NULL SubscriberSex char 2 NULL SubscriberBirthDate date NULL SubscriberRelationship char 2 NULL SubscriberEmploymentStatus char 2 NULL Subscriber_RejectReason1 char 2 NULL Subscriber_FollowUpCode1 char 1 NULL Subscriber_RejectReason2 char 2 NULL Subscriber_FollowUpCode2 char 1 NULL Subscriber_RejectReason3 char 2 NULL Subscriber_FollowUpCode3 char 1 NULL Subscriber_RejectReason4 char 2 NULL Subscriber_FollowUpCode4 char 1 NULL Subscriber_RejectReason5 char 2 NULL Subscriber_FollowUpCode5 char 1 NULL Subscriber_RejectReason6 char 2 NULL Subscriber_FollowUpCode6 char 1 NULL Subscriber_RejectReason7 char 2 NULL Subscriber_FollowUpCode7 char 1 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 112 Subscriber_RejectReason8 char 2 NULL Subscriber_FollowUpCode8 char 1 NULL Subscriber_RejectReason9 char 2 NULL Subscriber_FollowUpCode9 char 1 NULL DependentRelationship char 2 NULL DependentBirthOrder int NULL DependentName varchar 35 NULL DependentFirstName varchar 25 NULL DependentMiddleName varchar 10 NULL DependentSuffix varchar 10 NULL DependentIDQual char 2 NULL DependentID varchar 30 NULL DependentOtherlDQ
116. cates with You can do this in the Email Server Information frame of the setup screen Follow the instructions below 1 Select EDI Exchange Setup under the EDI Exchange menu item lt 2013 gt Martin Scholl Consulting Inc 213 HIPAA Authorizer Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request ED Exchange License EDI Exchange License Information The EDI Exchange Setup menu item 2 The following window will appear EDI Exchange Directory Setup Root Directory Path Browse SMTP Server _ Sender s email address F Send email notice of newly arrived Files BEEN ee User Name aaa Recipients SMTP server requires Logon A Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than f e set Count below Halt records if EDI compliance m warmings are found EDI Ales with Other Type in Inbox D EDI Exchange is NOT yet initialized Auto process if other program is available The EDI Exchange Setup window Leave file for other program 3 Specify the following email options lt 2013 gt Martin Scholl Consulting Inc EDI Exchange
117. ce to render the form in red or in black Note The data is always black Options for PDF e Use Content Compression Checking this option does result in considerably smaller files Options for TIFF e Color Depth You can change color depth of the image black white 4 bpp 8bpp 24bpp 32bpp Note TIFF in Window s GDI library does not work with 16 bpp bits per pixel Color depths set lower than 16 bpp results in some losses in image quality e Compression Algorithm You can use compression with TIFF files LZW and Packbits is used for all Colors CCITT4 for black and white e Image Resolution You can change the resolution of image from 96 to 300 dpi dots per inch Note Theoretically we could use even higher resolutions but it will slow down processing significantly and result in approximately the same result in quality 7 3 Viewing Images HIPAA Authorizer Image Viewer allows you to view images stored in the output folder defined in the image options See Adjusting Image Follow the instructions below to view images 1 To access Image Viewer select the Image Viewer option under Image menu item lt 2013 gt Martin Scholl Consulting Inc The Image Viewer menu 2 The Image Viewer window will open Image Viewer Creating Image Files and PDF s 164 Enrollment Record Meet Type Addition Medicare Big Aeron COMA Guattiang Evert Pot Waeb Elli Bige
118. chick C Connectto the SMTP server via the SSL protocol Use Port Outgoing Ales Other options O Validate outgoing files O Reject Incoming Files with more errors than l set Count below Halt records if EDI compliance warnings are found EDI Ales with Other Type in Inbox D EDI Exchange is NOT yet initialized Auto process if other program is available The Initialize EDI Exchange button Leave file for other program Once the Initialize EDI Exchange button is clicked the system checks if all settings have been configured correctly 1 The first thing the initialization process checks is the connection to the database and the presence of the necessary tables EDI Exchange relies on the database connection that is part of the HIPAAsuite application that you are using EDI Exchange needs Database Connectivity licensed and enabled If this part is not yet set up then you will get an error like this EDI Exchange intalizaton started Checking SQL settings and tables Could not establish connection EDI Exchange encountered the above errors EDI Exchange is not operational until everything checks out Initialization failed because of SQL connection problems Read more in Setting up Database Connection 2 Once the connection is established the program checks if the correct tables exist in the database See Creating Database Tables Once the SQL part checks out you will see the following message lt 2013 gt
119. ck EDI File Trading Partners Inbox Manager FTF Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request ED Exchange License EDT Exchange License Information A Y The EDI Exchange Setup menu item 2 The following window will appear ED Exchange Directory Setup Root Directory Path Fd SMTP Server _ Sender s email address E Send email notice of newly arrived Files User Name _ Password _ Recipients SMTP server requires Logon A Connectto the SMTP server via the SSL protocol Use Port O Validate outgoing files C Reject Incoming Files with more errors than set Count below Halt records if EDI compliance E warnings are found O EDI Files with Other Type in Inbox EDI Exchange ts NOT yet initialized aaah a Leave file for other program Auto process if other program is available The EDI Exchange Setup window Note The icon in the lower left corner indicates that EDI Exchange has not been initialized yet 3 Under EDI Exchange Directory Setup specify the following setting lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 206 e Root Directory Path Define the root path in the Root Directory Path text field The root path is the folder where all your EDI files reside EDI Exchange will later cre
120. cked the desired receiver for your request will then send the EDI request to the selected Trading Partner through the method you selected during the Trading Partner setup If the method selected was MIME or SOAP the request will be sent to the selected Trading Partner s MIME or SOAP service ss is send To Trading Partner lt 2013 gt Martin Scholl Consulting Inc 271 HIPAA Authorizer Sending an Eligibility Request using a DB Query To send an eligibility request created from a query first open the Create EDI Authorizations form 64bit Image Log Setup EDI Exchan Database Connection and Data Fields Table Creation Fields Mapping Stored Authorization Records Stored Requesters Stored Patients Stored Providers Create EDI Authorizations In the Create EDI Authorizations form first select the trading partner to whom you wish to send a request by clicking Select Trading Partner If no trading partners are listed you must enter them as shown in Setting up Trading Partners Selecting a trading partner will fill in the appropriate EDI fields in the ISA and GS segments when the EDI file is created lt 2013 gt Martin Scholl Consulting Inc HIPAAsuite RealTime Client 272 Create 278 TransactionSets 1 SELECT TOP 20 FROM EDI_AuthorizerHeader G Effective TEE Request E R arazos E las 312015 7 3 2015 Fields with will be populated by the process Exit Write to File
121. contact information to a request for Paperwork We can reject a request on the subscriber and or Patient level When we click the button Reject at Subscriber Level the reject screen comes up with the following reject reasons lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 68 15 Required application data missing 58 Invalid Missing Date of Birth 65 Invalid Missing Patient Name 66 Invalid Missing Patient Gender Code 67 Patient not Found 68 Duplicate Patient ID Number 71 Patient Birth Date does not Match Database T2 Invalid Missing Subscriberinsured ID f3 Invalid Missing Subscriberninsured Name T4 Invalid Missing Subscriberinsured Gender Coc 75 Subscriber insured not Found 76 Duplicate Subscriberinsured ID ff Subscriber Found Patient not Found fo subsceriberinsured seas in eo identified 79 Invalid Participant Identification 95 Patient not Eligible i Address N3 N4 Reject reasons on the subscriber patient level 3 5 Viewing Patient Event Level segments 3 5 1 Review Request When we click on the Patient Event Level tab we see on the first tab this screen lt 2013 gt Martin Scholl Consulting Inc e HIPAA Authorizer Requester Info SubscriberPatient Patient Event Level Provider Info Other UMO Service Event Level 3 9 2 Review Delivery Ambulance Chiropractor DME Oxygen Activities Limitations Health Care Serv
122. ction and Data Fields Table Creation Fields Mapping 1 SELECT 2 FROM AuthRequester 2 First Name XX National Provider Identifier STE 400 State Zip Country Code Subdivision WA Washington w 97852 Provider Code Specialty PE Performing y 103TC1900N Psychologist Counseling Contact Phone Extension Fax AMYLOU HARRIS 206 555 1212 555 206 555 1213 Email URL AMYLOU HARRIS OBAWASH ORG WWW OBAWASH ORG Additional Identifiers Provider UPIN 189UP7732 Provider Site Number Facility ID Plan Network ID EIN 524478594 Facility Network ID SSN Carrier Assigned Ref No Auto complete When we now enter a new request and type in the ID field the letter O we get prompted for our record depicted above lt 2013 gt Martin Scholl Consulting Inc Database Integration 146 Requester Info Subscriber Patient Specialty Requesting Physician Last Organization Name LIMPIA BEHAVIORAL ASSOC OLIMPIA BEHAVIORAL ASSOC and if we select the entry the form will fill a Create Authorization Requester info Requesting Physician Last Organization Name OLIMPIA BEHAVIORAL ASSOC Entity Type ID Type 2B Third Party Administrator ki i XX National Provider Identifier Address 2400 CEDAR HWY E First Name Middle Name _ DB 123546987 STE 400 City State OLIMPIA WA Washington bal Country Code Subdivision Provider Code Cont
123. d a UMO payer 11 2 Trading Partner Setup The HIPAAsuite RealTime Client can be used to consume a CORE compliant service hosted by a Trading Partner In HIPAAsuite Authorizer this means you can verify a patient s medial coverage in real time RealTime Client also supports batch mode transfers for larger or multiple Eligibility requests packaged in a single EDI file In order to consume a client s CORE compliant SOAP or MIME service the following steps must be taken lt 2013 gt Martin Scholl Consulting Inc 267 HIPAA Authorizer 1 You will need your Trading Partner s services URL address Some Trading Partners may have separate addresses for SOAP and MIME services both being specified in the CORE Connectivity Rules Real Time and Batch services or Batch request submissions and Batch request pickup 2 Head to your trading partner s configuration settings under the EDI Exchange menu Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Trading Partners menu item 3 The Trading Partners configuration window will appear If the Trading Partner for whom you are configuring the RealTime Client is already listed double click on the Trading Partner and skip to step 5
124. dNursingIndication char 1 NULL MedicareCoveragelndicator char 1 NULL HomeHealthCertificationType char 1 NULL HomeHealthRelatedSurgeryDate date NULL HomeHealthRelatedSurgeryQual char 2 NULL HomeHealthRelatedSurgeryCode varchar 15 NULL HomeHealthPhysicianOrderDate date NULL HomeHealthLastVisitDate date NULL HomeHealthPhysicianContactDate date NULL HomeHealthLastAdmissionFrom date NULL HomeHealthLastAdmissionTo date NULL HomeHealthFacilityType char 1 NULL PWK ReportType1 varchar 2 NULL ReportTransmCode1 varchar 2 NULL ReportID1 varchar 80 NULL ReportDescription1 varchar 80 NULL ReportType2 varchar 2 NULL ReportTransmCode2 varchar 2 NULL ReportID2 varchar 80 NULL ReportDescription2 varchar 80 NULL ReportType3 varchar 2 NULL ReportTransmCode3 varchar 2 NULL ReportID3 varchar 80 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 122 ReportDescription3 varchar 80 NULL ResponseReportType1 varchar 2 NULL ResponseReportTransmCode1 varchar 2 NULL ResponseReportID1 varchar 80 NULL ResponseReportDescription1 varchar 80 NULL ResponseReportType2 varchar 2 NULL ResponseReportTransmCode2 varchar 2 NULL ResponseReportID2 varchar 80 NULL ResponseReportDescription2 varchar 80 NULL ResponseReportType3 varchar 2 NULL ResponseReportTransm
125. dad dss E a T 82 Dental Procedure Soa A a A a EAE 83 DETUVO Ol CA A aaa aaa eas 84 Messages and Accompanying Pape rw OPK n sssssssssssnsnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnn nnnnnnnnnnnnn nnmnnn nnmnnn nnmnnn nnna 84 Service Line Provid l Sirisa a aa ara aai reaa aa aioa neasi 86 Part IV Responding to Requests 89 1 R jecting a Request ainia 89 2 Creating Me RESPONSE ss 92 3 Approval Modification and Rejection of valid request ococococccnocococcocococononcararanonnarararnnnanano 93 A VIEW EDI Pla aa a a a a 94 Part V Database Integration 98 TOVE MIE Ea a a a a aaa 98 2 Setting up an ODBC Connection sreerai a a a 98 3 DalaDase COMME CUON ies 100 A OG SODA E 103 PP 104 6 SOL Table SCH DUS tactica iba 106 T Creaung the Tables ii ido 141 8 Error Messages during export iaiici id 143 9 Requester Member and Provider c oococococcocococoncocococoncncaroronnncararnnnnnararnrnnnacararnnnanararnrnananaso 144 lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer Part VI 1 2 Part VII 1 2 3 Part VIII oa A W N Part IX 1 2 Part X Working with stored requests 149 Stored A a aE A e EEEE a E Ei 149 Create 278 MES iaa 151 Creating Image Files and PDF s 158 Creating Image FIle Sieros aca 158 Adjusting image OPUS a a E Ea 161 VIEWING MATES aa 163 Automation 167 CONCODIS ii 167 Fe FOCOSSING PO a E R EEEa a EEE A EERE EEE 167 File Processing with EDI Exchange sescioccicinccocininaccnn ac
126. dent State Accident Country r r Y Serice Level Current Condition Frognosis Info Release Delay Reason Other References Previous Administrative Previous Certification ID Rebre D Entity ID Additional Entity ID The Specialty Review Review screen There are 9 individual sub tabs on this screen The first one Review is visible above The information in the top frame goes into the UM segment with the first two elements Request Category and Certification Type being required fields The choices are all narrowed down to the values in the drop down lists of the fields Health Care Services Review Information UM Request Category Ce Xt AR Admission Review HS Health Services Review IN Individual SC Specialty Care Review I The choices for Request Category lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer 2 6 2 Certification Type 1 Appeallmmediate 2 Appeal Standard 3 Cancel 4 Extension 6 Verfication N Reconsideration PR Renewal 5 Revised Delay Reason The choices for Certification Type A second frame contains previous certification ID s which will be represented by REF segments and when the institutional bill type is chooses a third frame appears with institutional claim codes Usually Admission Type and Admission Source are needed for a valid request with the institutional bill type This information will create the CLI segment instituti
127. dled here Create Tables for EDI Exchange 4 Database Microsoft SQL Server Trading Partner COMPANY_SETUP TradingPartner Table script 1 CREATE TABLE dbo TradingPartner TradingPartnerlD varchar 15 NOT NULL TradingPartnerlD_QUAL char 2 NULL ETINNo varchar 15 NULL NAME varchar 40 NULL Contact varchar 100 NULL Phone varchar 15 NULL Extension varchar 10 NULL Email varchar 75 NULL Fax varchar 15 NULL LocalFtpUser varchar 20 NULL LocalFtpPassword varchar 20 NULL Address1 varchar 100 NULL Address2 varchar 100 NULL City varchar 30 NULL State char 2 NULL Zip varchar 10 NULL FtpAddress varchar 50 NULL PutDirectory varchar 50 NULL GetDirectory varchar 50 NULL FtpArchive varchar 20 NULL FtpUserName varchar 40 NULL FtpPassword varchar 40 NULL FTPPort varchar 12 NULL Outbox varchar 50 NULL The sercen to create able 3 Select the database type you use for your host HIPAA application e Database e Microsoft SQL Server SQL Server 2008 and above e MySQL Note In case your database is not listed modify the scripts or ask your database administrator to make the necessary modifications 4 The following tables are part of EDI Exchange e TradingPartner SQL statements to create the TradingPartner table in your database This table contains information about trading partners
128. e 51 Providers Detall isso 52 Saving a regue SU eesi o cds 53 VICWING a FE QUG St usar n 55 Editing a FOQUCSH a 56 Sending a request to a trading partner coocococcccocccconcocononcocnararnncarnnnarnrnarnrnararnnnarnnnararnanannns 56 lt 2013 gt Martin Scholl Consulting Inc Contents l 14 Deleting a Teques iii a 58 Part Ill Response Mode Viewing Requests 60 1 Loading Transactions TOM Te cian 60 2 Viewing Recordsin FORM A ias 62 3 Viewing Records in Edit ScreenS iiciin aa aa iaaa aaie 64 4 Viewing Subscriber or Patient Information ooccococococcnnonacononcanaroroncarararononnararnrnanarararnananano 65 5 Viewing Patient Event Level segments ocococococococococncncncnonnonononcncarararararorarnrnananananananananananas 68 REVIEW RE qUe a ide 68 A AO 69 A AAA A sans deens det teseeee ens 70 CIIFOPFAGIIC An vicateneeutesteceesestarsbectcecst 70 Durable Medical Equipment oc iia 71 Sn a o II a a 72 FUNCUONAL Limitation S ia diinidas 74 Mental Status iia a a E iaa 75 Home Hal ii aaa a alee an sew a ae aa E E pans eE aE a eects OEE 76 6 Viewing Provid r Informati n wiiescccschecesteesi alaaa Aaa l at ara Erlaa ana 77 7 Viewing other UMO Information sra e 79 9 SERVICE EVENT LEVO enic e a a E E EG 81 Viewing Proposed Services and RequeSt ssssssssssssssnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnmnnn nnmnnn nnne nnmnnn 81 Professional PFOCE dures Spinn eaa aE a a 82 Institutional Procedures iii aa ee e
129. e Identifier Type Patent Location The Home Health screen Home Health Certification Period From To _j j B _ E Related Surgery Date Physician Order Date JJ B7 FFl B7 Last Visit Date Physician Contact Date JJ By _ f By Last Admission Period From To _j_ B7 _ f B The Home Healthcare segment CR6 has up to 17 fields Prognosis Home Health Start Date Certification Type Code and MediCare Indicator are the only required ones lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 46 2 7 Providers The 278 transaction allows for up to 14 providers in loop 2010EA The HIPAA Authorizer allows for three whose information can be transmitted in the request For this we have the following screen Requester Info Subscriber Patient Specialty Review ProviderInfo Other UMO Service Detail Provider Type Name ID Type Provider ID Provider Information Provider Type ID Type ID Add Provider Info Last Name First Name Middle Name Address City State Zip Provider Code Specialty Contact Phone Extension Fax Email LIRL ID Qualfier ID Code License No State Code E The provider screen The screen above contains all the information that goes into loop 2010EA of the transaction set We see the name and ID the address contact and specialty information Information entered here will also apply to the detail level Note that you have to click on
130. e Trans_Log SQL statements to create the TRANS_LOG table in your database lt 2013 gt Martin Scholl Consulting Inc 193 HIPAA Authorizer This table contains incoming file information keeps track of all EDI files that you receive and the compliance check report e Trans_Log_Errors SQL statements to create the TRANS _LOG_ERRORS table in your database This table collects the results of the compliance check and keeps track of all sent files e Send_Log SQL statements to create the SEND_LOG table in your database The table contains information about EDI files created and sent to trading partners e Company_Setup SQL statements to create the COMPANY_SETUP table in your database This table collects information about you the sender of EDI information 5 You can modify the scripts so that they run on your specific database Once you have you modified the script click Save Tip Every database system has their own little syntax idiosyncrasies and the scripts might require tweaking You can edit the table scripts in this screen and save your modified scripts One example are date and time or money data types that do not exist in SQL Server 2005 You can just rename those types to datetime and save you script and it will run fine Create Tables for EDI Exchange O ES Database Microsoft SQL Server O MySQL Generic TRANS_LOG TRANS _LOG_ERRORS SEND_LOG COMPANY_SETUP
131. e choose a mode it will be indicated in the task bar Image Setup EDIE The chosen mode is indicated by the blue frame around the icon In this case the Response mode is chosen If we choose to create a request we will see the following screen lt 2013 gt Martin Scholl Consulting Inc 5 HIPAA Authorizer E HIPAA Authorizer 64bit a E File View CodeSets Database Image Log Setup EDIExchange Help E ram 2 gt Durk Work with File Database List of Authorization Requests Dependent Subscriber ID Ss 321654987 5 Manual Process B Save Requests to Database C Data Export C Show on screen C Print C Image File s Process Run with compliance check New Request Edit Request View Load More Records send To Trading Parner Refresh Query Settings M Limit quantity of records to show at once to fi Apply changes I Show records created during the period from 4 3 2015 to 4 3 2015 Show only records which are not sent yet No update available The main screen in request mode This is our workplace to create and manage requests Here we see all relevant requests and their status is clearly indicated In Response Mode we see this screen lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer 6 HIPAA Authorizer 64bit oO x File View Database CodeSets Image Setup EDIExchange Log Help mimi S OPA List of Authori
132. e information in this screen is equivalent to a claim line in a ADA 2006 form 3 8 5 Delivery of Care The following screen is important for services that stretch over a time and consist of several visits or special administration of services Review Info Professional Institutional Dental Delivery Paperwork i Msg Provider Health Care Services Delivery Quantity Quantity Qualifier Time Frame 3 WS Visits dl per 1 WK Weeks ll for Number of Periods Time Period Qualifier 3 34 Month nd Delivery Pattern Delivery Pattern Time SY Monday Wednesday and Thursday bl ll The Delivery of Services Display Window The above information translated means that the service should be delivered 3 times a week on Monday Wednesday and Thursday for 3 months For more information on how to code the health services delivery information please look into the 278 implementation guide All the fields in this screen can be edited because the response might contain different amounts of services periods or visits than the request 3 8 6 Messages and Accompanying Paperwork The following page displays a possible free form text message and information on accompanying paperwork This information can come with the request or it can be added to the response Again one of the few fields that are editable in the response mode lt 2013 gt Martin Scholl Consulting Inc es HIPAA Authorizer _Reviewinfo Professional Institu
133. e name of the UMO and up to 4 denial reasons and a denial date Up to three other UMO can be listed Note that you have to click on the Add Other UMO Info button to add the information to the request Only when you see the UMO in the top grid will it be in the transaction Loop 2010EC contains this information There can be up to three UMOs and the navigation is the bottom of the screen ld 4 1 of 1 Other UMO gt Fi Navigating between several UMO s lt 2013 gt Martin Scholl Consulting Inc st HIPAA Authorizer 3 8 3 8 1 Service Event Level Viewing Proposed Services and Request A 278 request can have many lines of service items which can be individually authorized When we click on the Service Event Level tab we see this screen T Review Info Professional Institutional Dental Delivery Paperwork Msg Provider Health Care Services Review Information Request Category Certification Type HS Health Services Review 4 Extension service Type 1 Medical Care Bill Type Facility Type B CMS Dental claim form 11 Office service Date Previous Certification ID 939393939 Previous Administrative Reference ID Period 93939399 Date Trace Numbers Trace Number Entity ID Additional Entity ID 993939000 1 8 7898909 484 3929 Reject at Service Level Adjudicate Request at Service Level ID EDI TRN 1 993939000 1 7857898909 484 73929 UM HS 4111 B REF BB 939393939 DTP 472 D8 20080620 SV 1 HC 404 9 2
134. ectivity The true power of the HIPAA Authorizer requires the support of a database to its functionality This way the program can write requests and responses to a database keep track of received transactions and join requests with responses In addition the program saves which user created a responses and places a time stamp to this information All the setup information is then also stored in the database and provider requesters and subscribers that have been manually entered can be saved and recalled for future use cutting down on the time it takes to create a request significantly Real Time Client The affordable care act mandated that payers add real time capability to their systems to answer requests by providers instantaneously In 2013 this capability was required for eligibility and claim status transactions 2014 added claim payment and in 2016 we will see the authorization transactions added to this requirement The mechanics of Real Time are quite complex The Coalition for Affordable Quality Healthcare CAQH developed the CORE standards that underlie this requirement Two very different transport mechanism have to be supported in order to become CORE certified as a payer There is the MIME Multi part standard which is relatively old and goes back to email transactions with attachments the second mechanism is SOAP the Service lt 2013 gt Martin Scholl Consulting Inc 11 HIPAA Authorizer 1 4 Oriented Architecture
135. eesseeeeeseeeeeeeseensaneeeennes 222 WOFkKING With Trading PANES ins 222 Seting up Trading Partners adn 222 using BUEN ET CHEN iei aa E nisi ant as anny eHnerne es 236 Creating a Trading Partner Automatically oooocccocononcncnnnnnccnnnnnccccnoonononnnnnnnnannnn cnn cnn rra anne rrrrrrnnnnnna 241 Certificate based authentication in SFTP aaa 242 RISING ENCON dos 245 A A sacaacaauandapeasnctaassancenschaaesanssensbadscsaetacs 245 lt 2013 gt Martin Scholl Consulting Inc Contents Setting Up Ener YOUN a aap Aa Aaaa aa Eaa AAEE 245 USING POGP DeS Koi ia a Ea a a Aa EEEE Aa cuidad 249 Using Gn PG aaeain aa as 250 6 Using EDI Exchange Features la 252 Access mo INDOxX ei 252 CHECKING EDL FIle S oiiire a a aaa a aa a aaia 253 Dow nloading EDI Files From FIP Serve T a a a a Eaa eaa 255 Proces SING EDU PNG St 257 ACCESSING EDI Receive Log rinie cesses ices a a aa aa aa Eaa a aaa a aaa aaia 258 Accessing EDISend LOG si A aaa a aaa aaaeaii 261 Listing SEF i a el Do 263 Part XI HIPAAsuite RealTime Client 266 L CONCEDPIS 2rsscscecszeccenescarcecnceseseusenesstaensaxcenandaccncuouheseuasuenst A E i EA a EAEan 266 2 gt Trading Partner S tup suis a a a E Ea 266 3 Sending Requests and Receiving RESPONSES ocococcococcoconcncononcononcononenronenrnnnnranonranonenennnnnns 270 Part XII Issue Tracking 275 1 Reporting an ISSU oa 275 Index 280 lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer 2 1 The
136. el ID Type ID SJ Service Provider 34 Social Security Number 987654321 Address N3 NA Contact Information PER Address Contact M TUCKER Tf HOLLY BLVD SECOND PART City State Zip E KANSAS CITY MO Missouri 64108 URL Phone 618 999 3456 Extension Fax 618 676 9304 Provider Information PRW Provider Code Specialty PE Performing 2030 50133X ee IDs REF TG Provider UPIN Number jee SJ Service Provider WATSON SUSAN _ 34 Social Security Number 987654321 SJ Service Provider WATSONZ2 SUSANZ 34 Social Security Number 98 7654321 MN Provider Type Name ID Type Provider ID The Provider Info screen The 278 standard allows for 14 separate providers at this level but we limited our database to 3 providers and in the bottom is the navigation tool The information in this screen forms the segments NM1 N3 N4 PER and PRV in the loop 2010EA MH d 1 of Providers b Ca al El r al i au a ri mm Navigating between the service providers You can reject the request at the provider level If you click the appropriate button the reject screen comes up with the following reject reasons lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer 3 7 15 Required application data missing 33 Input Errors 35 Out of Network 41 Authorization Access Restriction 43 Invalid Missong Provider Identification 44 Invalid or Missing Provider Mame 45 Invalid Missing
137. elcome message and click Next Scheduled Task Wirard This wizard helps you schedule a task for Windows to perfor You select the program you want Windows to run and then schedule it for a convenient time The Scheduled Task Wizard window 4 Browse to the nrpaaauthorizer exe executable file lt 2013 gt Martin Scholl Consulting Inc 175 HIPAA Authorizer Scheduled Task Wizard Click the program you want Windows bo run To see more programs cick Browse 7 ip File Manager Accessibilty Wizard QP ACDSee Pro 25 1 Address Book E Adobe Bridge CS3 Cl Adobe Device Central C53 ED A aha E iunt viet Tana The Scheduled Task Wizard window By default the application is located in c Program Files HIPAAsuite HIPAA Authorizer HIPAAAuthorizer exe Select Program to Schedule Look irc HIPAA Enrolment Master I pdf ico 85 PdfSharp ll SA 4 2odnterop AcroPOFLIb di f ProjectHisbory xt E 5 BetMracle LibTiff NET dl 8 OlmLicensetib dll 8 CustomActionLibrary ll A Shortcut to HIPAMEnrolmentMaster Desktop i Cuctoendicki vf Inst all sl Template ods E Template xls ai My Network Places Selecting a program to schedule Click Next 5 Type in a name for this task Choose a time interval e Daily lt 2013 gt Martin Scholl Consulting Inc Automation 176 e Weekly e Monthly e One time only e When my computer starts e When log on Click Next
138. emed to be the most secure method of file transport There are 3 methods of authentication in Sftp 1 with a user name and password 2 with a user name and a private key cryptographic certificate and 3 with a user name a certificate and a password lt 2013 gt Martin Scholl Consulting Inc 243 HIPAA Authorizer When you select SFTP as the FTP protocol you will see two check boxes appear SFTP User password Auth private Key Auth The sub choices when you select SFTP Leaving both check boxes unchecked will result in the first option Authentication with user name and password You can also check just the user name and password with the same result In order to use the certificate based authentication you need to create and link to your own certificate The certification module that HIPAAsuite employs uses a so called private key SSH2 certificate in pem format How do you create such a certificate Here is one way The free secure shell program putty has the necessary tools Download putty from www putty org When you install the program you will see several program installed on your computer Organize Include in library Share with Burn New folder de Mozilla Maintenance Service Marne l Date modified Type Size ae L LICENCE 8 6 2013 6 12PM File 2 KB Js aida e TAE pageant exe 8 6 2013 6 12 PM Application 144 KE d els ds ER plink exe 8 6 20136 12PM Application 304 KB d kai EP pscp exe 8 6 20136 12
139. ents allow to call the program either from the Windows Scheduler or batch scripts or via shell commands File Processing This first part is for those who don t not have the EDI Exchange module enabled In order to run the HIPAA Authorizer from the command line or have it invoked through another program it is necessary to pass command line arguments to the program to instruct it to perform the desired tasks Command line arguments are separated by commas 1 The first argument after the program name is the file or directory name where the source EDI files are located The application automatically finds out if this argument is a file or a directory 2 The second argument indicates the output option Valid arguments are e P Printer e TIFF or PDF image file e X Database export The arguments above are concerned with the processing of incoming EDI files But the export of EDI transactions can also be automated and run through the command line The syntax is as follows 1 The first command is your SQL Query 2 EDI 3 The file name for the resultant EDI transaction is defined on the third place If left lt 2013 gt Martin Scholl Consulting Inc Automation 168 blank then the default path and file name will be used If you just give a directory then the default file name will used in that directory Tip The application window must be closed Otherwise the CLI commands do not run Example 1 This example c
140. er program is available The EDI Exchange Setup window 3 Specify the following outgoing files options Outgoing Files e Validate outgoing files Select this checkbox to validate if the outgoing files are HIPAA compliant e Halt records if EDI compliance warnings are found Select this checkbox to suppress the sending of files with warnings or errors EDI Exchange Directory Setup Root Directory Path D4EDN SMTP Server Sender s email address C Send email notice of newly arrived Files smtp gmail com example gmail com Add User Name Password EEE SMTP server requires Logon user arre P example email com Connectto the SMTP server via the SSL protocol Use Port Outgoing File Other options Validate outgoing files Reject Incoming Files with more errors than p set Count below C Halt records if EDI compliance warnings are found EDI Riles with Other Type in Inbox O EDI Exchange is NOT yet initialized Exchange a Save Auto process if other program is available Validating outgoing files 4 Specify the following incoming files options Other Options lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 22 e Reject incoming files with more errors than set count below If checked the incoming files with more errors than defined will not be placed into the Inbox folder EDI Exchange Setup ia Root Directory Path DAEDA SMTP Server sender s email address smtp gmail com ex
141. eral Public License We recommend Gpg4Win for encrypting of your files and emails Gpg4Win supports both relevant cryptography standards OpenPGP and S MIME X 509 and is the official GnuPG distribution for Windows Gpg4Win contains Kleopatra as one of its Free Software components For more information see Gpg4Win documentation available both in PDF and HTML versions lt 2013 gt Martin Scholl Consulting Inc 251 HIPAA Authorizer Import Certificates Export Certificates Redisplay Stop Operation Lookup Certificates on Server Find My Certificates My Certificates Trusted Certificates Other Certificates Name E Mail Valid From Valid Until Details Key ID Martin Sc Martin Schol 2011 12 10 OpenPGP C1F4C4C8 Kleopatra a certificate manager for OpenPGP and X 509 S MIME and common crypto dialogs With Kleopatra it is easy to manage your certificates and create your own ones It seamlessly integrates with GnuPG You can manage the key that you receive from your trading partners because there is a screen to view the details of a key A Certificate Details User IDs and Certifications Technical Details This certificate is currently valid User ID Chiftaengine Co lt chiffaengine gqmail caom gt Validity from 2011 06 19 12 09 until forever Certificate type 2 046 bit RSA Certificate usage Signing EMails and Files Encrypting EMails and Files Certifying other Certificates Key ID B399D4A0 Fingerprint BCS
142. ernet protocols and goes back to the 1960 s Transporting electronic files was one of the great achievements of the internet During the last 50 years a lot of improvements to this protocol have been made mainly to increase the security of the transfer e FTP For security reasons EDI Exchange supports secure FTP or FTPs e Explicit FTPS Connection The explicit method is a legacy compatible implementation where FTPS aware clients can invoke security with an FTPS aware server without breaking overall FTP functionality with non FTPS aware clients In explicit mode also known as FTPS an FTPS client must explicitly request security from an FTPS server and then step up to a mutually agreed encryption method If a client does not request security the FTPS server can either allow the client to continue insecure or refuse limit the connection Implicit FTPS Connection The implicit method requires that all clients of the FTPS server be aware that SSL is to be used on the session and thus is incompatible with non FTPS aware clients Negotiation is not allowed with implicit FTPS configurations A client is immediately expected to challenge the FTPS server with a TLS SSL ClientHello message If such a message is not received by the FTPS server the server should drop the connection In order to maintain compatibility with existing non TLS SSL aware FTP clients implicit FTPS was expected to listen on the IANA Well Known Port 990 TCP for t
143. es can also be checked and individual transaction in violation of HIPAA rules can be held back Note You can enable automatic compliance check on outgoing and incoming EDI files See Setting up Incoming and Outgoing Files Options Follow the instructions below to check EDI files for compliance 1 Select Check EDI File under the EDI Exchange menu item EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create ED Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerre Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Check EDI File menu item Alternatively you can click on the Select and Check EDI File button in the Inbox Manager window Read more in Accessing Inbox Manager lt 2013 gt Martin Scholl Consulting Inc 255 HIPAA Authorizer Check EDI File Loading EDI Files into Inbox Processing Inbox Select and Check EDI File Dolce ones dl Bil Activity Log and Warnings Filename 140123142208h x12 SEF file HIPAAClaimMaster SEF_Files 837_005010X222A1 SemRef SEF loaded for transaction set 005010X222A1 The Transaction type is 837 Version 005010X222A1 Passed No Errors No Warnings The file has 1 Interchanges 1 Functional Groups and 1 Transaction Sets The file contains 4 Claims The Select and Check EDI File button 2
144. es digital certificates which map public keys to entities securely stores these certificates in a central repository and revokes them if needed A PKI consists of e A certificate authority CA that both issues and verifies the digital certificates e A registration authority which verifies the identity of users requesting information from the CA e A central directory is a secure location to store and index keys e A certificate management system EDI Exchange relies on other software to establish the PKI It only uses the capabilities of these programs through their Application Programming Interface API You need to separately install either PGP Desktop or the open source GPG4Win programs and set them up with the public keys of your trading partners and your own private key Setting up Encryption EDI Exchange allows you to set up the encryption for your EDI files Follow the steps below 1 Access the Encryption Setup window by selecting Encryption Setup under the EDI Exchange menu lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 246 EDI Exchange Check EDI File Trading Partners d ae Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The encryption setup menu 2 The followi
145. esponse store it in the database and connect the request to the response Apart from the manual mode it is of course possible to create the database records for the requests through another separate process and use the Authorizer to create the EDI file the communications with the payer and to populate the database with the responses so that possibly a separate process consumes those data The following picture shows the start up screen of the HIPAA Authorizer lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer HIPAA Authorizer 64bit JO xj File View Database CodeSets Image Setup EDIExchange Log Help a 20709 M Counter Files Records E Choose Program Mode Manual Process There een Request Authorization Give Authorization C Data Export Show on screen C Print C Image File s Process T Run with compliance chech No update available _ The Start up screen of the HIPAA Authorizer Here we have the option to choose between the two program modes Request and Response On top you have the main menu through which you can address every function of the program underneath the tool bar with Icons to the most common functions The Info bar on the left side controls the processing of files Most prominent are the 2 cartoon figures which humorously express the two separate modes that the HIPAA Authorizer runs under Request mode and Response mode Once w
146. ewise if this Trading Partner does not have a different address to distinguish RealTime from Batch mode they are the same address Currently only username tokens are supported Fill in the username and password textboxes with the credentials your Trading Partner has provided you for use of their CORE compliant service These will identify you to this Trading Partner when requesting a patient s eligibility information User credentials and CORE compliant service addresses Both are required for successful communication Sending Requests and Receiving Responses There are two methods of sending requests via the HIPAAsuite RealTime Client and by extension MIME or SOAP to a desired Trading Partner Sending an Eligibility Request using the Workgrid After creating an authorization request using the request mode and the Manual Entry method it will be presented on the workgrid as follows m ID Requester Subscriber Dependent Subscriber ID 1 ORLANDO BEHAVIORAL HEALTH DOW JOHN 321654997 5 List of Authorization Requests If you are having trouble finding the correct request try filtering by date created or unsent requests only Query Settings Apply changes V Limit quantity of records to show at once to Show only records which are not sent yet Having located the record to be sent click on Send to Trading Partner This will present you with a selection of Trading Partners and having double cli
147. fic address o SOAP Submission Address Trading Partner s web address for SOAP Batch transactions o SOAP Retrieval Address Some Trading Partners may use a different address to submit or retrieve batch transactions Use this field for a retrieval specific address 10 4 2 Using Built in FTP Client EDI Exchange has a built in FTP client This utility allows you to drop off and pick up files from a trading partner that you have defined in the Trading Partners menu see Setting up Trading Partners Follow the instructions below to exchange EDI files with your Trading Partner 1 To access the FTP client select FTP Client under the EDI Exchange menu item lt 2013 gt Martin Scholl Consulting Inc 237 HIPAA Authorizer EDT Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The FTP Client menu item 2 The following window will appear Password o FTP Secure FTP O SFTP lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 238 The built in FTP client 3 Click the Connect to Trading Partner button on the FTP client window Password Directory FTP Secure FTP SFTP The Connect to Trading Partne
148. fiers Options Remote FTP Contact Encryption Folders CORE CORE Settings UserName Batch Password MIME Submission Address Test SSL Certificate MIME Retrieval Address Real Time en Test MIME Address e SOAP Submission Address SOAP Address SOAP Retrieval Address CORE settings tab e UserName UserName portion of the username authentication token Used to verify a Trading Partner s Username tokens Username or in your own Username token authenticate yourself to a Trading Partner s CORE compliant servi e e Password Password portion of the username authentication token Used to verify a Trading Partner s Username token s Password or in your own Username token to authenticate yourself to a Trading Partner s CORE compliant service e SSL Certificate Instead of Username tokens use an SSL certificate to verify a Trading Partner s identity or access a Trading Partner s CORE compliant service Not currently implemented e RealTime lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 236 o MIME Address Trading Partner s web address for MIME Real Time transactions o SOAP Address Trading Pertner s web address for SOAP Real Time transactions e Batch o MIME Submission Address Trading Partner s web address for MIME Batch transactions o MIME Retrieval Address Some Trading Partners may use a different address to submit or retrieve batch transactions Use this field for a retrieval speci
149. file The ISA identifier can be up lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 228 to 15 bytes long the qualifier has to be 2 bytes Approved qualifiers are e 01 Duns Dun and Bradstreet e 14 Duns Plus Suffix e 20 Health Industry Number HIN e 27 Carrier Identification Number as assigned by HCFA e 28 Fiscal Intermediary Identification Number as assigned by HCFA e 29 Medicare Provider and Supplier Identification Number as assigned by HCFA e 30 U S Federal Tax Identification Number e 33 National Association of Insurance Commissioners Company Code NAIC e ZZ Mutually Defined Many organizations use the ZZ qualifier with their name as the ID for example ZZ and HIPAASUITE e ETIN number The Electronic Transmitter Identification Number established by a Trading Partner Agreement This number occurs only in the 837 transactions Often the ETIN is same as the ISA ID Application Receiver Code GS_02 A code identifying a part that sends a transmission or the specific application within the sender s organization Codes are agreed by Trading Partners Again usually this code is same as the ISA ID This code is placed in the GS_02 element in the Functional Group Header GS Some Trading Partners want to send a specific code in GS_03 the application receiver code You can enter it into the corresponding field Most of the time it is not necessary Assigned ID Some tradin
150. following screen lt 2013 gt Martin Scholl Consulting Inc z Transaction Log ca 2 Monday September 29 2014 Mr SELECT TOP 20 ld UMOName Status RequestorName SubscriberName SubscriberFirstName DependentName DependentFirstName SubscriberID FROM EDI_AuthorizerHeader WHERE Status IS NULL OR Status lt 3 ORDER BY ld SELECT TOP 20 ld UMOName Status RequestorName SubscriberName SubscriberFirstName DependentName DependentFirstName SubscriberID FROM EDI_AuthorizerHeader WHERE Status IS NULL OR Status lt 3 ORDER BY ld The Trading Partner with the ID SUBMITTERS ID is not set up File 278_5010_Request ed processed at 9 29 2014 3 03 28 AM Number of Claims in File 1 The Trading Partner with the ID SUBMITTERS ID is not set up File 2783_5010_Request ed processed at 9 29 2014 9 06 15 AM Number of Claims in File 1 The Trading Partner with the ID 12455739012345 is not set up File 273_5010_Response ed processed at 9 29 2014 9 42 44 AM Number of Claims in File 1 Processing of the file 278_5010_Response edi began at 9 29 2014 11 37 17 AM Records Images will be created Processing ended at 9 29 2014 11 37 24 AM The file D Temp 278 Response Files 2014 September 29 273_5010_Response pdf has been created The Trading Partner with the ID 12455739012345 is not set up Another instance of the program is running Aborting at 9 29 2014 12 00 43 PM Another instance of the program is runnin
151. g Aborting at 9 29 2014 12 03 01 PM The log screen 9 2 File Logs The HIPAA Authorizer in conjunction with the EDI Exchange module has also file logs in addition to this simple text log Incoming and Outgoing file logs are saved to the database and give a complete report on all files that the software uses lt 2013 gt Martin Scholl Consulting Inc EDI Exchange tea 10 EDI Exchange 10 1 Getting Started 10 1 1 About EDI Exchange EDI Exchange is a module available in most HIPAAsuite EDI applications It is an option that you can purchase for an additional cost Some of our products such as HIPAA Claim Master process EDI files but do not receive or send EDI files to and from your trading partners EDI Exchange is created to do that EDI Exchange is designed for those organizations that have a large volume of EDI files need more order and automation and adhere to tougher compliance rules The EDI Exchange is an EDI pre processor that handles FTP transport encryption HIPAA compliance check trading partner management etc Outgoing EDI files can be checked for compliance individual records that do not pass the check can be withheld HIPAAsuite products with EDI Exchange module have a main menu item called EDI Exchange with sub menus to call the module s functions HIPAA Enrollment Master 32bit File View Database CodeSets Image Setup Log EDI Exchange Help ELF a Check EDI File a gt lo iQ 4 Tr
152. g partner s FTP server download files decrypt and compliance check them and further process them with the appropriate HIPAAsuite application for example load claims into a SQL lt 2013 gt Martin Scholl Consulting Inc 221 HIPAA Authorizer database Follow the instructions below to schedule the EDI files exchange process 1 Select Automatic Scheduler under the EDI Exchange menu EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Automatic Scheduler menu item 2 In the opened window right click and choose the Scheduled Task menu item File Action View Help e ea 3 Task Scheduler Local 4 Task Scheduler Library Status Triggers NextRunTime LastRunTime LastRunResult Author Created gt E Microsoft p E MySQL Create Basic Task C HIPAASuite Create Task Import Task Create Basic Task 4 Display All Running Tasks Create New Task 5 Enable All Tasks History Import Task New Folder Refresh Delete Folder View Refresh Y Help Task Scheduler in Windows Vista onwards lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 222 In Windows XP the Scheduled
153. g partners like health insurance exchanges will give a plan an ID that is different from the ISA identifier defined in the Company Setup screen of the application Especially in the creation of filenames is this Assigned ID important Options Tab lt 2013 gt Martin Scholl Consulting Inc 220 HIPAA Authorizer EDI Identifiers Options Remote FIP Contact Encryption Folders CORE 4 Send EDI Acknowledgement 997 or 999 Send e mail with compliance check and process results Send e mail notification when receiving Files Send e mail notification when sending Files E Reject Files with Compliance Errors EDI Exchange Create a 27 CA for 837 Claims One ST SE loop per claim The Options Tab You can choose one of the following options e Send EDI Acknowledgment 997 or 999 This check box allows sending Functional Acknowledgment transactions to the Trading Partner e Send e mail with compliance check and process results This option allows sending the compliance check results back to your contact at the Trading Partner via email No PMI will be transmitted Adding an email address is important even when the Communication method is not Email e Send e mail notification when receiving files This option allows sending an acknowledgment email of EDI files This option is not necessary when you choose 997 or 999 acknowledgments e Send e mail notification when sending files This option allows
154. har 2 NULL Provider3_FollowUpCode4 char 1 NULL Provider3_RejectReason5 char 2 NULL Provider3_FollowUpCode5 char 1 NULL Provider3_RejectReason6 char 2 NULL Provider3_FollowUpCode6 char 1 NULL Provider3_RejectReason7 char 2 NULL Provider3_FollowUpCode7 char 1 NULL Provider3_RejectReason8 char 2 NULL lt 2013 gt Martin Scholl Consulting Inc Database Integration 128 Provider3_FollowUpCode8 char 1 NULL Provider3_RejectReason9 char 2 NULL Provider3_FollowUpCode9 char 1 NULL Other UMO 1 OtherUMO1EntitylD char 2 NULL OtherUMO1Name varchar 35 NULL OtherUMO1DenialReason varchar 50 NULL Other UMO1AddDenialReason1 varchar 50 NULL Other UMO1AddDenialReason2 varchar 50 NULL Other UMO1AddDenialReason3 varchar 50 NULL OtherUMO1DenialDate date NULL Other UMO 2 OtheruMOZ2EntitylD char 2 NULL OtherUMO2Name varchar 35 NULL Other UMO2DenialReason varchar 50 NULL Other UMO2AddDenialReason1 varchar 50 NULL Other UMO2AddDenialReason2 varchar 50 NULL Other UMO2AddDenialReason3 varchar 50 NULL OtherUMO2DenialDate date NULL Other UMO 3 OtheruMO3EntitylD char 2 NULL OtherUMO3Name varchar 35 NULL Other UMO3DenialReason varchar 50 NULL Other UMO3AddDenialReason1 varchar 50 NULL Other UMO3AddDenialReason2 varchar 50 NULL Other UMO3Add
155. hd il The Create Table form There are six tables that belong to the HIPAA Authorizer Beside the Header and Detail table to store the request we have tables for the requesters patients and providers that help speed up the manual entry of authorization requests Lastly the company setup table can also be created Here we test first if you have this table already and prevent you from deleting and recreating it Warning Executing the scripts will wipe out any previous tables that you created Remove the script files once you are satisfied so nobody can destroy the tables by lt 2013 gt Martin Scholl Consulting Inc 143 HIPAA Authorizer 5 8 accident Error Messages during export When you start exporting claims into the stagin tables you might enconter errors at first This usually results from table definition issues The HIPAA Authorizer displays a very detailed error message that tells you which request failed at what field and if applicable which line This information should help you to trouble shoot the problems We try to give a meaningful error message Below are typical error messages here from the HIPAA Claim Master They tells us that the Table EDI_Claims is missing the column ClaimNo The HIPAA Authorizer will show equivalent error messages Export Error _ x Error while updating Claim header table EDT Claims Error 3265 Item cannot be Found in the collection corresponding to the re
156. he FTPS control channel and 989 TCP for the FTPS data channel This allowed administrators to retain legacy compatible services on the original 21 TCP FTP lt 2013 gt Martin Scholl Consulting Inc 231 HIPAA Authorizer control channel e SFTP also known as FTP over SSH is deemed the most secure form of FTP and uses encryption certificates There are 3 different ways to authenticate a SFTP connection With user name and password just like a regular FTP connection User name and a certificate User name certificate and password Remote Connection and Directories You need the FTP address the user name and password to establish the connection and the directory information where files are picked up and where dropped off Fill in the following fields e FTP Address This is usually the IP address of the server e User Name e Password e Put Directory This is the directory where you drop off files e Get Directory This is the directory where you download files from It is possible that a trading partner has two FTP servers one for put and another one for get If so check Different Download Server and additional fields will become visible so you can specify the those connection parameters After Download You have two choices Files on the server will be either deleted or moved to another folder of your choice Contact Tab The Contact Tab stores contact information for your selected Trading Part
157. he fields specific to the RealTime Client are the EDI File Exchange Method dropdown selection in the main configuration window and the CORE tab on the bottom of the Same window You can select either CORE or MIME from the EDI File Exchange Method to send messages to your trading partner using the RealTime Client E Selecting MIME or SOAP will use the RealTime Client to send EDI requests to this trading partner 6 To flag the trading partner as OK for EDI transfers the Status field must be set to Active or Test Only Test Only is only for testing and will enable you to use unsecure http addresses to contact your Trading Partner The Approved option flags enables secure transfers to this trading partner Approved will let Authorizer know this is a trusted Trading Partner 7 Lastly the CORE settings tab Settings dealing with addressing and user credentials are stored here Type in the addresses for this Trading Partner s SOAP or MIME servers Some Trading Partners listen on different addresses for RealTime and Batch transfers lt 2013 gt Martin Scholl Consulting Inc 11 3 HIPAAsuite RealTime Client 270 and some even have distinct addresses for Batch Mode request submissions and Batch Mode results retrieval Spaces for all of these are provided If this Trading Partner doesn t have a different service address for Batch Mode result retrieval the address is the same as for Batch Mode request submission lik
158. he requester icon on the task bar on top ge Log Setup _ Gf When we select the Request Mode we will see the following main form lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 26 HIPAA Authorizer 64bit Al ES File View CodeSets Database Image Log Setup EDIExchange Help p gt 2s fa 0709 Workwith File Database List of Authorization Requests Requester Subscriber Dependent Subscriber ID Ss Records sd ra ORLANDO BEHAVIORAL HEALTH DOW JOHN Manual Process Save Requests to Database C Data Export Show on screen C Print C Image File s Process E Run with compliance check New Request Edit Request View Load More Records send To Trading Partner Refresh Query Settings Limit quantity of records to show at once to fi Apply changes F Show records created during the period from 4 3 2015 to 4 3 2015 Show only records which are not sent yet No update available _ The main form in request mode In the center of the form we see the workplace grid Here you will see all the requests that are manually entered loaded from files or loaded from the database This workplace grid is the central part of the software from here you can enter new requests edit existing requests view requests in a printable form and see the status of individual requests whether they passed compliance check are
159. health This tab lists conditions and procedures that are administered at home and not at the office Services range from a temporary rehabilitation to hospice care for terminally ill patients lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer Review Delivery Ambulance Chiropractor DME _ Oxygen Activties Limitations Mental Status Home Health Home Health Care Information Home Health Certification Period From To 7 Less then 6 Month to Live 04 29 2005 if Prognosis Home Health Start Date Certification Type Related Surgery Date Physician Order Date Initial pl ff Medical Procedure Identifier Last Visit Date Physician Contact Date i If Last Admission Period Patient Location From To Pl fi The Home Health screen The Home Healthcare segment CR6 has up to 17 fields Prognosis Home Health Start Date Certification Type Code and MediCare Indicator are the only required ones 3 6 Viewing Provider Information When the 278 request is a review request for a specialist or for care by a provider other then the requesting provider then the following page will display information such provider information When we click on the Provider Info tab we see this screen lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 78 Provider Info Provider Information Provider Name NM1 Last Name First Name Middle Name WATSON SUSAN Provider Type Reject at Provider Lev
160. ices Review Information UM Request Category Certification Type Bill Type SC Specialty Care Review Initial A UB claim form Serice Type 3 Consultation Facility Type Related Causes Accident State Accident Country 11 Hospital Inpatient Including Medicare Part A service Level Current Condition Prognosis Info Release Delay Reason Y Yes Provider has a Signed Statement Permitting Release ol Other References Previous Certification ID 4123 Previous Administrative Reference ID 123 Institutional Claim Codes Admission Type Admission Source Nursing Home Residential Status 3 Elective Patient Status Trace Numbers Trace Number Entity ID Additional Entity ID 2001042801 9012345676 CARDIOLOGY Here we have basic information on the request such as category and bill type facility and so on Delivery Health Service Delivery which is stored in the HSD segment can further explain and narrow the service for which authorization is sought Delivery Activities Limitations Mental Stat Health Care Services Delivery Quantity Quantity Qualifier Time Frame 1 VS Visits ll per 1 DA Days for Number of Perods Time Period Qualmer 10 7 Day Delivery Pattern Delivery Pattern Time lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 70 The Health Service Delivery tab Here we see a request for daily visits for 10 weeks 3 5 3 Ambulance The tab for a
161. igure the following options e Company Information e EDI Version e Contact Information e ISA 14 and 15 Read the detailed descriptions further 13 HIPAA Authorizer Indicates Mandatory Fields ISA Segment Sender Identifier HIPAASUITE Qualifier ZZ Mutually Defined Application Sender s Code GS_2 HIPAASUITE Tax ID 521685500 Plan ID Payor ID Three letter identifier to prepend HPS to all outgoing EDI files Entity Type Code ISA 14 and 15 EDI Files will be a Test B Production O Acknowledgement TAT req 1 Once you have finished editing the options click Save lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer a Company Information e Name Company name Obligatory option e Address 1 e Address 2 e City Obligatory option e State Obligatory option e ZIP e Plus 4 e ISA Segment Sender Identification It is the most important option to choose It identifies your organization for all EDI transactions Most commonly the Qualifier ZZ and a free form ID up to 15 character in length is chosen Other options include your tax ID and the Dun amp Bradstreet ID e Qualifier The ISA Identifier and qualifier are the unique key to the trading partner database file The ISA identifier can be up to 15 bytes long the qualifier has to be 2 bytes Approved qualifiers are e 01 Duns Dun amp Bradstreet e 14 Duns Plus Suffix e 20 Health Industry Num
162. ion HIPAA Claim Master for example The reason is that EDI Exchange will work on all HIPAAsuite Products that are installed on your particular computer For example if you have HIPAA Claim Master and HIPAA Enrollment Master licensed only one license of EDI Exchange is needed and the module will work across two products When you first install a HIPAAsuite product of your choice a 15 day EDI Exchange trial is included Once the trial expires EDI Exchange loses its functionality The menu items under EDI Exchange become disabled except the last ones that allow you to license and enable the product lt 2013 gt Martin Scholl Consulting Inc 189 HIPAA Authorizer Data Base Code Sets gt 15 4 E 80 C Data Import Claim Type a 0 ri A NE E The EDI Exchange menu with menu items disabled EDI Exchange Help Check EDI File Logs Image Setup Trading Partners LICEE LH CUMBERLAND FILIAL eo LPT TECK EPOHI EH o Inbox Manager FTP Client SEF Files 3 a Ll EMP EDEN PEEL E OPEP TP eee A La AFA IIA oe ri BL EP ao i A i A MS N a BE Sesser 19 00 EDI Exchange Setup oe OP REE CRT FPA LEELEE AS AA IA i a Encryption Setup Create EDI Exchange Tables ar Create 999 Files Tables a Autoprocess Setup E fi Automatic Scheduler upg F mel EDI Receive Log EDI Send Log L J Request EDI Exchange License EDI Lic
163. iption and screenshot to Bug IDF 8 Thank you Figure 7 Acknowledgement of Issue submission lt 2013 gt Martin Scholl Consulting Inc 279 HIPAA Authorizer Now this bug has been submitted we will be notified by email and you will get updates on the issue lt 2013 gt Martin Scholl Consulting Inc te Index sC a Creating the Response 92 D Delivery of Care 84 Introduction 2 Ls Loading X12 278 EDI files 60 Messages and Accompanying Paperwork 84 Ts these steps 266 V Viewing Authorization and Services Review Records 62 Viewing Proposed Services and Request 81 Viewing Subscriber or Patient Information 65 lt 2013 gt Martin Scholl Consulting Inc Back Cover
164. ipulation Service Information Treatment Series Treatment Count Subluxation Level Subluxation Level Code ll 1 5 Nature of Condition Complication Indicator Are X Rays available A Acute Condition Y Yes Y Yes Patient Condition Description Patient Condition Description ll Chiropractic Certification Information 14 Ambulation is Impaired and Walking Aid is Used for Mobility The above conditions Apply Do not Apply The Chiropractor screen In the upper part is information for the CR2 segment which list subluxation levels and and conditions The lower part has more condition codes that go into the CRC 08 segment Durable Medical Equipment Often the use of durable medical equipment such as wheel chairs or hospital beds has to be authorized In this screen we find such justifications lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 72 Review Delivery Ambulance Chiropractor Durable Medical Equipment Conditions 29 A6 hour nocturnal study documents 30 episodes of apnea each lasting more than 10 seconds The above conditions Apply Do not Apply Viewing DME information 3 5 6 Oxygen Therapy Oxygen Therapy is most of the time done at home Patients with severe breathing problems and diminished lung function get equipped with oxygen bottles or generating equipment The screen consists of two parts the first part lists the conditions necessitating the oxygen therapy
165. ironment they will be sent via https This means every service needs an SSL Certificate signed by a recognized certificate authority and every EDI message sent through https will be sent encrypted and can only be decrypted by its intended recipient With the Affordable Care Acts ACA or Obamacare adoption of the EDI connectivity rules developed by the Coalition for Affordable Quality Healthcare CAQH a consortium of healthcare industry providers and insurers the need They devised and prescribed mechanisms to transfer eligibility information in real time between two computers These new CORE standards will greatly enhance the efficiency of establishing insurance coverage for a patient reducing the wait time to under a minute CAQH s CORE standards for administrative data exchange are rolled out in segments referred to as Phases The HIPAA RealTime Client is CORE Phase Il certified meeting all connectivity and data content rules specified therein The HIPAA Authorizer s RealTime Client requires EDI Exchange It will allow you to send EDI 278 requests securely to the trading partner of your choice and process the resulting EDI 278 response file Although named RealTime the client does support batch mode EDI transfers for large or bundled eligibility requests Though the 278 transaction set is not yet mandated under the CORE rules we at HIPAAsuite feel that this technology could be beneficial to the exchange of authorizations between a provider an
166. ished in the Windows Control Panel with newer versions having the ODBC Data Source Setup under the Administrative Tools OleDB connections use a database specific data access object or dll The Authorizer comes by default with MS SQL Server s data access object Contact us for a modification if you have a different OleDB provider lt 2013 gt Martin Scholl Consulting Inc 101 HIPAA Authorizer Click on the Menu item Database gt Connection and Data Fields Table Creation Fields Mapping Stored Authorization Records Stored Requesters Stored Patients Stored Providers Create ED Authorizations Manual F The database menu and the following screen will show Database Server Setup for OLE ODBC Connection HIPAAsuite s Authorizer Fields to be exported Header aw a Data aw V Authorizer Details a V Header iD a gt Er Segment Y TraceOriginator po Y TracelD Connection Properties pd Y TraceReference Database Ti a um Segment Database Server Name ASQLExpress Database hipaasuite Username aw dia Information Password pd aaa Y RequestorName Y RequestorFirstName M ProcedureCodeType Y RequestorMiddleName ProcedureCode Authorizer Header Table Name W RequestorSuffix Y Modifiert EDI_AuthorizerHeader W RequestoriDQual Modifier2 5 You can create the bU RequestoriD Y Modifier3 Authorizer Detail Table Name tables through a J RequestorOtherID
167. l loose all the data in the table To avoid this trouble there is the button Compare Script with existing Table you click this the table structure in your database will be compared with the script There are two possible outcomes Your table is up to date You have all the fields in your table There is nothing to do or if your table is missing recently added fields you will see a window pop up that shows an Alter Table script with which you can add those fields to the table without interfering with existing data In the latter case you can click the Execute Script button and the field will be added and a message will confirm your changes lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 22 Alter Table statement successfully executed 10 2 4 3 Defining Auto Processing Options In the Auto Process Setup you can instruct the program on what to do after analyzing and decrypting the received files in the Inbox Manager The auto processing enables you to combine and run multiple fulfillment steps together for example export saving printing These options are important for the hand over from EDI Exchange to the other HIPAAsuite program that hosts EDI Exchange Follow the instructions below to specify the Auto Process Options 1 Select EDI Exchange Autoprocess Setup in the main menu EDI Exchange Check EDI File Trading Partners AR Inbox Manager FTF Client SEF Files EDI Exchange Se
168. le was not recognized as a valid EDI file Parser Error Segment ISA Error ISA segment has not enough elements It will not be processed The file was moved to C 3 SuspendedFiles Otheritest_test edi on 2 15 2013 at 3 58 PM 2 Files processed Activity Log and Warnings information 10 6 5 Accessing EDI Receive Log EDI Exchange has a file log Each processed file creates an entry in the Trans_Log table You can access the EDI Log window to query this table and see what files came in and how they were processed You can access the EDI Receive Log once the application has been initialized Follow the instructions below 1 To open the EDI Log window select EDI Receive Log under the EDI Exchange menu item lt 2013 gt Martin Scholl Consulting Inc 259 HIPAA Authorizer Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recene Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The menu for the FDI Receive Log 2 To display data specify the time period and select trading partner e Time Period Period of time when the file was processed Choose one of the available options e Receive Date e Load Date e Trading Partner Name You can select your trading partner from the list If you select A
169. ll all your trading partners will be included 3 Click on the Find Log Files button to see the list of log files corresponding to your query lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 20 Specifying the time period 4 The log will be displayed in form of a tree EDI Log Displayed log 5 You can open the folder icons and see details related to each file lt 2013 gt Martin Scholl Consulting Inc 261 HIPAA Authorizer 10 6 6 EDT Log EDI Files Specify the time period in which the file E E Query was processed Sy 1902990005 Tirst_cloim_missing DTPOS6 ed Trans Type 3837 Time Period Trading Partner PLEASE FILL THIS RECORD From 2 26 2013 Receive Dal Compliance Check Date 04 27 2012 Compliance Check Time 1 30 PM Result Waming in Line 16 gt DESCRIPTION Missing mandatory segment in EDI file Segment PAT is expects To 2 26 2013 LoadDate Warming in Line 21 gt CLM A37P1H555 3025 0013 A 1 at Postion 6 DESCRIPTION No data in mand Warning in Line 21 gt CLM A37 H555 3025 0013 4 1 al Postion 9 DESCRIPTION No data in mand Trading Partner Name Waning in Line 21 gt CLM A37YH556 3025 00 13 A 1 al Postion 18 DESCRIP TION Mo data in man Waming in Line 25 gt HIBK 7840 Z7 at Position 2 at SubElement 2 DESCRIPTION No data in mand Warning in Line 28 gt NM17
170. lts and we can see the EDI file below lt 2013 gt Martin Scholl Consulting Inc 155 HIPAA Authorizer Processing Results SQL Query SELECT TOP 20 FROM EDI _AuthorizerHeader Number of records to process 3 Number of records in file 6 Number of rejected records 2 EDI creation ended at 08 48 25 The process results are displayed on the screen Note this information will also be verbatim in the log file if you choose to log manual process logging in the setup lt 2013 gt Martin Scholl Consulting Inc Working with stored requests 156 Create 278 TransactionSets 1 SELECT TOP 20 FROM EDI_AuthorizerHeader Effective Date 0 Request i 12 3 2014 O Response Fields with t will be populated by the process View EDI File Select Trading Partner ISA segment Password ID Type Sender ID ID Type Receiver ID Date Time Interchange ID Ack T P ISA 00 ZZ HIPAASUITE ZZ CMSFFM 141203 0848 00501 337084805 0 vT GS segment ST segment Sender Code Receiver Code Group Control Not Version Transaction ID 5010 ID GS Hi HIPAASUITE ARO 20141203 0848 433700001 X 005010X217 ST 278 0006 005010X217 ISA 00 ga ZZ HIPAASUITE ZZ CMSFFM 141203 0848 00501 337084805 0 T GS H I HIPAASUITE ARO 20141203 0812 433700001 X 005010X217 51 278 0001 005010X217 BHT 0007 11 433700001 20141203 0812 18 HL 1 20 1 NM1 X3 2 HIPAASUITE 46 521685500 PER IC MARTIN SCHOLL TE 3016139572 EM MART
171. luding that which they are obligated to support by HIPAA with the HIPAA Authorizer Authorization requests come via 278 file The simplest use manual mode would be to display the request on screen and to compose the response to the request and send it back A case worker can in this scenario process many request in the course of the day The HIPAA Authorizer can be connected to a database so that all requests and responses are preserved in a SQL database and can be recalled or processed later The database can be accessed through a separate outside process and authorizations for many procedures could be generated by some rule engine to be developed by others This process can then add the information needed for a valid response to the tables and the HIPAA Authorizer can then package the information into a 278 response file and send it back to the requesting provider Automating large parts of the processes realizes the true savings of employing EDI in the business flow All this can be automated through command line arguments Such automatic processing of authorization requests should include the validation of the request so that deficient or incorrect data in a request can be reported back with AAA lt 2013 gt Martin Scholl Consulting Inc 3 HIPAA Authorizer segments with the appropriate error message HIPAA Authorizer for UMO s Utilization Management Organizations UMOs often perform third party services either for paye
172. mbulance review is quite complex Several segment flow into this Chiropractor DME_ Oxygen Activiies Limitations Mental Status Home Health Ambulance Conditions 01 Patient was admitted to a hospital The above conditions 2 Apply Do not Apply Ambulance Transport Information Weight Unit Ambulance Transport Code Description of Trip Purpose 155 LB Pounds T Transfer Trip Distance Unit Ambulance Transport Reason Justification for Stretcher Use A Patientwas transported to nearest facility ft Transport Locations Pick up Location Drop off Location Final Scheduled Destination Next Destination Next Scheduled Destination Name Address PATIENT DIALYSIS CENT 77 HOLLY BLVD City State Zip Request Validation HOLLYWOOD CA California 90214 The Ambulance tab On top we have the ambulance conditions from the CRC 07 segments Here are descriptors for the patient s condition that justify the use of an ambulance Next is the ambulance transport information that goes into the CR1 segment and lastly are 5 locations that are connected to ambulance service such as pick up and drop off from the loop 2010EB 3 5 4 Chiropractic Care The Chiropractor tab has the necessary information to request the care of a lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer 3 9 9 chiropractor Review Delivery Ambulance Chiropractor DME _ Oxygen Activiies Limitations Mental Status Home Health Spinal Man
173. ming files you can specify an acceptable error level These settings are especially important with new trading partner relationships or with new processes since it always takes a while until an EDI process runs without issues and problems Follow the instructions below 1 Select EDI Exchange Setup under the EDI Exchange menu item EDI Exchange Check EDI File Trading Partners ae Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information di a A i TCU E A The EDI Exchange Setup menu item 2 The following window will appear lt 2013 gt Martin Scholl Consulting Inc ag HIPAA Authorizer EDI Exchange Directory Setup Root Directory Path SMTP Server _ Sender s email address Send email notice of newly arrived Files rN User Name a Recipients SMTP server requires Logon Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than set Count below Halt records if EDI compliance m warnings are found EDI Ales with Other Type in Inbox DI Exchange is NOT yet initialized ce O ee ere inma a Leave file for other program Save Auto process if oth
174. mo You will have to purchase this software if you want to continue using It after a free evaluation has expired Registration Number oo The Trial Screen You can see clearly the registration number in the lower left hand corner Registration Number FOGBBFACA The Registration number This number is needed for the registration as well as trial extension It is unique to your computer and hardware You can copy the registration number to the clip board just hover with the mouse over it so that you can easily paste it into an email This avoids human error There are no O the letter in the number only zeros lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer 8 Registration Number FOGREACA Copy the registration number to the Windows clip board by hovering over the it with the mouse Once you have received the license key from us you click on the Register button and the license registration from comes a Registration Form License Registration Form License Key Entering the registration information Enter the License Key as supplied in our email It is best to copy and paste the information from our email Once the product is registered with a permanent unlock code future upgrades will find this key and install without further action necessary lt 2013 gt Martin Scholl Consulting Inc 9 HIPAA Authorizer 1 3 Features and Licenses The HIPAA Authorizer h
175. n creating request records that will be sent to another trading lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer 1 7 1 8 partner Delimiters Setup EDI is all about delimiters By describing in the first 106 bytes of any EDI file which delimiters are used in the rest of the document the EDI file is machine readable There are 4 delimiters used in HIPAA EDI The element separator is the 4th byte of any EDI file It separates the elements of the segments All HIPAAsuite products default to for the element separator The sub element separator is defined in byte 105 and serves to divide elements further HIPAAsuite default is the colon The Repetition separator is used since the 5010 version of EDI and indicated in ISA_11 Our default is the caret The segment separator is byte 106 and used to separate the individual segments of an EDI file Our default is the tilde HIPAAsuite products allow you to set the separators freely to any value that is allowed by the X12 committee You use the following screen al Delimiters FA E ya Element Separator Subelement Separator Repettion Separator Segment Terminator Restore Default Values The delimiter screen Code Maintenance EDI relies on transaction code sets These codes represent longer explanations and lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer e descriptions At the onset of EDI one of the main design
176. n multiple fulfillment steps together for example export saving printing 1 Once Downloading EDI Files From FTP Server is completed and no errors are displayed click on the Process Inbox button This will autoprocess all files present in the EDI inbox directory lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 258 Inbox Manager oy x Check EDI File gt gt M Processing Inbox Select and Check EDI File Download from FTP Server Download from FTP Server _ M Activity Log and Warnings Checking FPT servers at 3 40 15 PM 1 Trading Partners are set up for FTP transfer Checking for files at Trading Partner PARTNER1 Successfully connected to PARTNER 1 s FTP directory File test_testedi deleted on server 1 Files moved from FTP Servers into Inbox Ll CiProgramDiats HIPAA suite HIPAA Enrollment W 1 Files moved from FTP Servers into Inbox The Process Inbox button 2 Once the processing is completed review the Activity Log and Warnings information Inbox Manager A ES Check ED File Loading EDI Files mto Inbox 77 Processing Inbox Scloct ond Check ED Fis Dewstoad tom FIP Server GA 7 Allfles in Inbox have been processed M Achwity Log and Warnings Filename 834 09 edi SEF file HIPAAEnrollmentMaster SEF Files 834_X09541_SemRetSEF loaded for transaction set 004010X095A1 llename test testedi The fi
177. n the Program Options you can determine if processed files should be deleted or moved and into which directory See Configuring Program Options lt 2013 gt Martin Scholl Consulting Inc tet HIPAA Authorizer 9 9 1 Logs The Application Log The HIPAA Authorizer can log its activities This is especially helpful when running the program automatically through the scheduler see Running the Application via Scheduler Notice To start logging the activity activate the Log All Processing Except Viewing option See Configuring Program Options In case of any problem the first thing is checking the log where all actions and all error messages related to an EDI file or written down and saved Follow the instructions below to access the log files for your HIPAA Authorizer Click Log Daily Log in the main menu EDI Exchange Og Accessing the log via the menu Help Daily Log This menu allows you to see today s log if it exists You can select other dates using the date picker or by typing in the date box Log files are simple text files one for each day that are stored in date hashed folders Alternatively access the Logs folder in the following directory Windows XP C Documents and Settings All Users Application Data HIPAAsuite HIPAA Authorizer Logs Windows 7 Vista C ProgramData HIPAAsuite HIPAA Authorizer Logs This folder might be invisible Once you click this menu item you will see the
178. nd folders Ol Drive Encryption can be centrally deployed and managed by Symantec Encryption Management Server lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 250 PGP Desktop key benefits 1 Secures email without burdening users to improve compliance with policies and regulations without hindering productivity 2 Allows users to easily and transparently share encrypted files and folders improving data security without impacting user productivity 3 Management by Encryption Management Server centralizes creation deployment and management of data security policies and reporting PGP Desktop bundles the following products 1 Drive Encryption See System Requirements 2 Desktop Email Encryption See System Requirements 3 Encryption Management Server See System Requirements 10 5 4 Using GnuPG GnuPG is an Open Source project for the implementation of the OpenPGP Pretty Good Privacy protocols of encryption GnuPG allows to encrypt and sign your data and communication features a versatile key management system as well as access modules for all kinds of public key directories GnuPG also known as GPG is a command line tool with features for easy integration with other applications Front end applications and libraries are also available Version 2 of GnuPG also provides support for S MIME GnuPG is a free software so it can be freely used modified and distributed under the terms of the GNU Gen
179. ne Select area Foreground window Current screen Delay Seconds Description Create new bug Update existing bug Bug ID Figure 2 The BugTracker Net screen capture facility If you click on Capture you can snap a picture of your screen lt 2013 gt Martin Scholl Consulting Inc 277 HIPAA Authorizer E BugTracker NET Screen Capture 1 2 3 gt 5 6 7 3 3 Figure 3 With a section from the underlying screen Enter as much information into the description as possible You can enhance your screen shot with drawings By pressing any key and holding down the mouse while over the canvas you either highlight in yellow free draw in red or make red arrows You can high light sections 02 21 2001 Figure 4 High lighting a section You can draw circles lt 2013 gt Martin Scholl Consulting Inc Issue Tracking Draw with mouse while pea any key Unde Figure 5 Circling a section You can point arrows to pinpoint your concerns Sve a5 Copyt to gt Clipboard Draw with mouse while pressing any key NTT wot 0227201 1 UN a 0802 gt uziziiz o 4 UN 41 E RARE APRA A A E 0001 Dc dan de Re Figure 6 Drawing an arrow Now please enter your email address so that we can get in contact with you and indicate whether this is anew bug or a follow up on an existing issue Then click on Send Posted your descr
180. ner lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 232 EDI Identifiers Options Remote FTP Contact Encryption Folders CORE Contact Information Contact Name Communication Numbers Number 1234567 0011171 Local Access for FIP and HIPAAsuite Web User Name Registered Users Password The Contact tab Contact Information Enter the name and the number into the corresponding fields and select the communication type from the drop down list e Contact Name e Communication Numbers Valid Communication number qualifiers are e TE Stands for Telephone e FX Stands for Fax e EX Stands for Extension e EM Stands for email Click the Add button and the contact will appear in the Communication Numbers table Note The information that you fill in goes also into EDI files in the PER segment Local Access for FTP and HIPAAsuite Web To register a user enter the user name and the password into the corresponding fields and click the Add button The user will appear in the Registered Users table e User Name e Password lt 2013 gt Martin Scholl Consulting Inc 233 HIPAA Authorizer e Registered Users Encryption Tab EDI Exchange supports PKI encryption Encryption keys are defined by the email address of the owner Both supported products PGP and GnuGP use this logic Read more in Using Encryption You can set up the encryption par
181. ner does not exist you have the opportunity to create a rudimentary new trading partner record Now you have the choice to either create this new record process the file without the trading partner record or to abort the operation New Trading Partner The sender of this file with the ID of MDSCRIPTS is not setup as Trading Partner Do you wantto create a new record The New Trading Partner dialog box If you abort the process you still will get the EDI file analysis lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 242 Inbox Manager Loading EDI Files into Inbox Processing Inbox Download from FTP Server All files in Inbox have been processed Activity Log and Warnings Filename keyhealth 837 SEF file HIPAACIaimMaster_ SEF_Files 837_X098A1_SemRef SEF loaded for transaction set 004010X098A1 The Transaction type is 837 Version 004010X098A1 The Trading Partner with the ID MDSCRIPTS ts not set up The file s further processing is suspended 346 warning messages were given The following Warnings with the X12 implementation were found Warning in Line 2 gt GS HC MDSCRIPTS KEYHEAL TH 20121012 1607 0000 1 X 0040 10X098A1 at Position 6 DESCRIPTION Lea Warning in Line 6 gt REF Z2Z 264101398 DESCRIPTION Unexpected data segment REF encountered in transaction set message Warning in Line 11 gt NM1 85 2 KEY HEALTH DEMO at Position 8 DESCRIPTION No data in mand
182. ng Inc EDI Exchange 204 Automatic Processing Options Get Ales from Trading Partners W Check FTP servers for new files and place them into Inbox Default Automatic Processing Options 4 Export in Database W Print Use printer Fax Save to W Image W Excel 7 ASCII The Save button Once you have saved the auto processing options the files will not only be analyzed but also processed according to the defined settings Proceed to the next step Defining Communications Directory 10 2 5 4 Defining Communications Directory EDI file directory is an obligatory setting you need to set up before starting using the EDI Exchange In order to keep track of the thousands of EDI files that accumulate over time EDI Exchange uses a folder structure which we call the HIPAAsuite Communications Directory or HIPAAsuiteCommDir in short In it you will find all your EDI files sorted into several categories e Inbox e Outbox e ProcessedFiles e EncryptedFiles e SuspendedFiles Within these directories there will be folders for each Trading Partner and type of transaction The location and names of the sub folders are handled in the Trading Partner Setup See Setting up Trading Partners Follow the instructions below to specify EDI communications root directory 1 Select EDI Exchange Setup under the EDI Exchange menu item lt 2013 gt Martin Scholl Consulting Inc 25 HIPAA Authorizer Che
183. ng window will appear lt 2013 gt Martin Scholl Consulting Inc 247 HIPAA Authorizer Encryption Setup General Encryption Options Onginal Unencrypted Outbound Files Name email for Public Key Keep a copy in an UnEnCrypted Folder Delete the original File Pass Phrase for Private Key Crypto Program 2 GnuPG GnuPG Path to gpg exe The program didnt find GnuPG executable Please specify path manually or download GnuPG installation from http www gqnupg org SFTP Client Path to private key file Pass Phrase for Private Key Save The encryption setup screen 3 In this window define the following options General Encryption Options e Original Unencrypted Outbound Files e Keep a Copy in an Unencrypted Folder When the HIPAAsuite program creates an EDI file for a trading partner that has selected encryption you can keep an unencrypted copy in the Outbox trading partner Unencrypted folder This is useful when you need to go back to the file and check on problems Note Once you encrypt a file with the public key of your trading partner you will not be able to open it again Only the owner of the private key can decrypt it and read it e Delete the Original File If you do not want to keep the unencrypted copy select this option e Key Pair Information lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 248 e Name e mail for Public Key Enter name or e mail tha
184. nships with your trading partner Follow the instructions below 1 Select Trading Partners under the EDI Exchange menu lt 2013 gt Martin Scholl Consulting Inc 223 HIPAA Authorizer Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDT Exchange License Information The Trading Partners menu item 2 The following screen will appear lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 224 EDI Version amp 4010 5010 EDI Identifiers and Qualifier The Trading Partners window 3 Click the New button to start entering the trading partner information 4 Define the necessary options They are described further lt 2013 gt Martin Scholl Consulting Inc 225 HIPAA Authorizer Name and Type Name Required Address City EDI File Exchange Method EDI Version 4010 5010 EDI Identifiers and Qualifier ISA Identifier and Qualifier Record Key x ETIN Number and Qualifier Application Sender Code 6502 46 Application Receiver Code 6503 Trading Farrer Assigned ID 5 Click on Save The Save button 6 The newly added Trading Partner s name will appear in the right pane Trading Partner Options The company information of a t
185. o type ODBC in the search box in the top right corner of the screen ODBC 32 bit Administrative Tools a Set up data sources ODBC 17 search Windows Help and Support for ODBC lt 2013 gt Martin Scholl Consulting Inc Database Integration 100 Link to the Data Source Setup Tool When you click on it you will see this screen User Data Sources Mame Driver dBASE Files Microsoft Access dBASE Driver dbf ne Excel Files Microsoft Excel Driver xls 2xdsx odsm MS Access Database Microsoft Access Driver mdb accdb MyODBC Linunc MySQL ODBC 5 1 Driver MyODBC Windows MySQL ODBC 5 1 Driver Visual FoxPro Database Microsoft Visual FoxPro Driver Visual FoxPro Tables Microsoft Visual FoxPro Driver T An ODBC User data source stores infomation about how to connect to the indicated data provider A User data source is only visible to you and can only be used on the curent machine The ODBC Administration screen Please consult Windows Help or the internet on specific data source setups 5 3 Database connection The HIPAA Authorizer relies on Open Database connectivity ODBC or in the case of Microsoft SQL server on OleDB to connect to a database This means that any database that adheres to the standards of ODBC are suitable to interact with the HIPAA Authorizer ODBC connections have to be set up in Windows first before you can use this feature Typically ODBC connection are establ
186. odification and Rejection of valid request The main segment for the response is the HCR segment That is where the information from this screen goes The first combo box let s us choose a certification action code Health Care Service Review Certification Action Code R Ad Certified in Total AS Not Certified Ad Pended Ab Modified C Cancelled CT Contact Payer NA No Certification required r The available action codes Next comes a certification or authorization number This will be listed on a later health care claim In case we reject the request for other reasons that listed in the formal reject reason we have choose a reason from the drop down box lt 2013 gt Martin Scholl Consulting Inc Responding to Requests 94 04 Authorized Quantity exceeded 15 Required application data missing 33 Input Errors 35 Out of Network 36 Testing not included 37 Forwarded to external Review Organization 41 Authorization Access Restriction 42 Unable to Respond at Current Time 43 Invalid Missong Provider Identification 44 Invalid or Missing Provider Name 45 Invalid Missing Provider Specialty 46 Invalid Missing Provider Phone Number 4T Invalid Missing Provider State a 49 Provider is not Primary Care Physician 51 Provider is not on File 52 Service Dates Not Within Provider Plan Enrollment 53 Inquired Benefit Inconsistent with Provider Type 56 Inappropriate Date 5f
187. onal Claim Codes Admission Type Admission Source Nursing Home Residential Status Patient Status Lastly the Trace elements are displayed They belong into the TRN segments and are used to re associate the response with the request Trace Numberz Trace Number Entity ID Additional Entity ID Health Service Delivery Health Service Delivery which is stored in the HSD segment can further explain and narrow the service for which authorization is sought Here one can express delivery specific information for example 6 visits within 6 months or delivery details like Monday Wednesday and Friday in the morning lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 38 Health Care Services Delivery Quantity Quantity Qualifier Time Frame Number of Perods Time Period Qualifier Delivery Pattern Delivery Pattern Time Content of the Delivery tab Examples of valid Delivery of Care conditions The following values represent One visit per every three days for 21 days Delivery Ambulance Chiropractor DME Oxygen Health Care Services Delivery Quantity Quantity Qualifier Time Frame 1 WS Visits per 3 DA Days for Number ofPeriods Time Period Qualmer 21 Day Here values for 1 visit on Wednesday and Thursday in the morning Health Care Services Delivery Quantity Quantity Qualifier Time Frame 1 WS Visits bd per for Number of Ferods Time Period Qualifier Deli
188. or later retrieval You can create image files containing the data that you see in Screen mode The following formats are supported e TIFF e PDF No third party software is needed as this feature is integrated into the software The image file name comes either from the EDI file name or the subscriber s ID which is mandatory and unique within a file You can create image files manually or automatically using the command line arguments and Windows Scheduler Read more in e Using the Command Line Arguments CLI e Running the Application via Scheduler Before creating image files make sure all settings are defined correctly The following options can be defined e Put all the images into a single file with multiple pages or have an image file for each authorization record e The form or background color e The image format TIFF or PDF e The image file directory In order to avoid having all images in one folder the images can hashed across folders based on the date Read more in e Configuring Program Options e Adjusting Image Options Follow the instructions below to create an image file from EDI file lt 2013 gt Martin Scholl Consulting Inc 159 HIPAA Authorizer Notice The image file will be created based on the pre defined settings Read more in Adjusting Image Options 1 Open an EDI file or directory containing the EDI files in the HIPAA Authorizer File View Setup Help gt OZO es 3 i
189. orde 171 Pile Grea HOM iiaa a a a aa 171 Changing the Default Company cccsccsceeseeesceenseeenseesnsesenensenenscesaseeensesonensoneasensasonsnees 172 Running the application through the Windows Scheduler ocoococcccoconnoconccconcnconencononcanonos 173 Logs 181 ENESADPICAWON LOG visa 181 PIS LOOS A das 182 EDI Exchange 184 GONG Stardust i EARE 184 ABOUE EDI BONING E cis ici 184 Requesting EDI Exchange LICONSA adi s 186 Registering EDUCA A a 188 Configuring EDI Exchange Obligatory Settings ococcococconocooccconcaroncanaconcnconcnnnanannananns 191 1 Setting up Database Connection aaa 191 ra EA A AE N AAE 191 2b Creating 999 File Tables snaran aE SNS 196 3 Defining AUtO PFOCESSINO OPONSE 202 4 Detining Communications DISCO dd aa 204 5 Initializing EDI Exchange iii aana e Ea a aAa aa aaa ahaa ORAA AECE RET 206 Configuring EDI Exchange Optional Settings coccococconocconoconcoconcaroncararoararonrarnacarnananns 212 Setting up Email Notifications eisni eonan iaaea aaaea aai aaar aa aaa aa Aaa aae a aaa aaiae haaa a AAAA aa aaae 212 Setting up Incoming and Outgoing Files Options ccssssssesseneseeeeessseeeneseseeeeeeeeeeeeeseensaneeesoneeeeeesseeeeeneas 218 Running the Application via Scheduler cecessssseessesseeeeeeeeeeeneeneeeeeeneeeeeeseeeeeeessesenneneseeeoeseeesesessennaneneenans 220 Using the Command Line Arguments CLI cccsssssseeeeeeeeeeeeeenseeeeeseeneeeeeeseeeeeeeseseenn
190. ore requests in the grid and click on Send to Trading Partner A screen will come up prompting us to select the trading partner from the ones we have on file lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer FLORIDA HOSPITAL HEALTH SYSTEM MARYLAND HEALTH BENEFITS EXCHANGE Selecting a trading partner We click on the appropriate trading partner Then the EDI file will be created and a success message pops up after the file has been written to the trading partner s outbox If encryption and or FTP transport have been set up for the trading partner the file is also then encrypted and transported via FTP If the trading partner is setup for real time transport such as MIME and SOAP the message will than be wrapped into the appropriate envelope and send immediately The program then waits for the response and will display in the status column that a response has been received If we double click now the request row in the workplace grid we will see the response displayed lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 58 2 14 Deleting a request When working from the database in the workplace you will be able to delete records from the database by selecting a record and right clicking then clicking Delete Record You can achieve the same result by selecting a record and pushing the delete key nr amh m View Request Edit Request Send to Trading Partner Right
191. ox to save requests to the database when loading a file for manual response 3 2 Viewing Records in Form When we click on the View Request Button or right click menu option we will see a rendered version that shows us all the information in it in a readable and printable fashion lt 2013 gt Martin Scholl Consulting Inc e HIPAA Authorizer HIPAA Preview y ox Filename 278_5010_Request ed Trading Partner ID SUBMITTERS ID Document Date 12 31 1999 8 02 AM Transaction ID 200300114000001 Transaction Purpose Request Request 1 UMO Utilization Management Organization UMO Name ABC PAYER Electronic Transmitterldentification Number ETIN 123450000 Requester Provider Name GARDENER JAMES Federal Employer ID 000012345 Provider UPIN Number 123456 Facility ID Number 223457 Address 43 SUNRISE BLVD SUITE 234 City KANSAS CITY State MO Zip 64108 Requester Contact WILBER Phone 818 999 1234 Fax 818 876 9304 Requester Provider Type Consulting TaxonomyCode 203B50133X Subscriber Name SMITH JOE MemberID Number 12345678901 Social Security Number 123456789 Address POBoxSub 171021 TEST ADDRESS City KANSAS CITY 5tate MO Zip 64108 Subscriber DOB 03 22 1958 Subscriber Sex Male EmploymentStatus Active Military Overseas Patient Event Trace Number 2001042801 Assigning Entity ID 9012345678 Assigning Entity AdditionallD CARDIOLOGY Request Category Specialty Care Review Certification T
192. proposed and need authorization 2 9 3 Health Service Delivery Detail On this screen we can specify the healthcare service delivery and compose an HSD segment in the 278 transaction on the service detail level 2000F Information here over rides information in a possible HSD segment on the patient event level Health Care Services Delivery Quantity Quantity Qualifier Time Frame per for NumberofPerods Time Period Qualifier Delivery Pattern Delivery Pattern Time Health Service Delivery information on the detail level lt 2013 gt Martin Scholl Consulting Inc 51 HIPAA Authorizer 2 9 4 Examples of valid Delivery of Care conditions The following values represent One visit per every three days for 21 days y Ambulance Chiropractor DME _ Oxygen Health Care Services Delivery Quantity Quantity Qualifier Time Frame 1 WS Visits per 3 DA Days ll for Number ofPeriods Time Period Qualmer 21 J Day Here values for 1 visit on Wednesday and Thursday in the morning Review Delivery Ambulance Chiropractor DME _ Oxygen Activities Limitations Mental Status Health Care Services Delivery Quantity Quantity Qualifier Time Frame 1 WS Visits ll per bl for Number ofPeriods Time Period Qualifier Delivery Pattern Delivery Pattern Time SA Wednesday and Thursday D A M Message Paperwork Here is the only place in the highly structured 278 transaction where you can enter free
193. quested name or ordinal in Sub Write SOL Claim Claim Counter 1 with Provider s Claim Number 13235 Field ClaimMo Value 13235 Cancel Error in the Header Table Here an error message from the detail table again from the HIPAA Claim Master Here we see that the field LineNumber is missing lt 2013 gt Martin Scholl Consulting Inc Database Integration NES Export Error on X Error while updating claim detail table EDT ClairnDetail Error 3265 Item cannot be Found in the collection corresponding to the requested name or ordinal in Sub Write SOL Claim Claim Counter 1 with Provider s Claim Number 13235 Field LineMumber Value 1 Line Number 1 nel Error in the Detail Table These is a typical error message Other typical errors are e The data type in the target database does not allow certain characters or nulls e The column width is too small for the data By carefully analyzing the message one can clearly identify the problem and eliminate those errors quickly Feel free to consult with support if you run into problems 5 9 Requester Member and Provider The database contains 3 tables that store data for further reuse You can save a lot of time by having the database fill up all the fields related to a particular entity The stored records can be recalled and administered here lt 2013 gt Martin Scholl Consulting Inc 145 HIPAA Authorizer Conne
194. r button 4 The following screen opens Trading Partner Selecting a Trading Partner for FTP transfer 5 Highlight the trading partner that you want to connect to 6 Click on the Upload button to connect to the Put directory that you set up in the trading partner screen Trading Partner The Upload button Or click on the Download button to connect to the Get directory that you set up in the trading partner screen lt 2013 gt Martin Scholl Consulting Inc 239 HIPAA Authorizer Trading Partner List of Trading Partner Pamer 1 The Download button 5 Once you have chosen a trading partner the following fields will contain values derived from the trading partner s properties You can change them manually if you need e FTP server IP Address or URL of the FTP server e Username e Password e Directory If you leave this value blank the FTP root directory will be opened e Secure FTP If you enable this option then you can select between implicit and explicit FTPs See Setting up Trading Partners for an explanation of the two secure methods e Explicit FTPS Connection e Implicit FTPS Connection Note You can also fill in the connection information manually In this case the entered credentials will not be saved once you close the FTP client window Click on the Connect button to e
195. r 123456 Facility ID Number 225457 Address 43 SUNRISE BLVD SUITE 234 City KANSAS CITY State MO Zip 64108 Requester Contact WILBER Phone 818 999 1254 Fax 818 876 9304 Requester Provider Type Consulting Taxonomy Code 203B50133X Subscriber Mame SMITH JOE MemberlD Number 12345672901 Social SecurityNumber 125456789 Address POBoxSub 171021 TEST ADDRESS City KANSAS CITY State MO Zip 64108 Subscriber DOB 03 22 1958 Subscriber Sex Male Employment Status Active Military Overseas Dependent Name SMITH MARY FatientAccount Number 321456789 Address PO Box 171021 TEST ADDRESS City KANSAS CITY State MO Zip 64108 Dependent DOB 03 22 1988 DependentSex Female Relationship Child Patient Event Trace Number 2001042801 Assigning Entity ID 9012345678 Assigning Entity Additional ID CARDIOLOGY Request Category Specialty Care Review Certification Type Initial Service Type Consultation Facility Type Hospital Inpatient Including Medicare Part A Bill Type UB claim form Release ofinformation Yes Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim The form to view a 278 Authorization request All cryptic codes are translated and the information is grouped by the segments in which it is contained This form is printable and can even saved as TIFF or PDF file lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 56 2 12 Editing
196. rading partner can be specified on the top of the form lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 226 Trading Partners Name and Type Mame Required Address City State Zip EDI File Exchange Method Status Email 4ddresses to send process results Type Top area of the Trading Partners window Name and Type e Name Trading partners company name Required field e Address Trading partner s company address e City e State e Zip e Status Trading partner s status Choose one of the available options e Inactive No upload into a database system through ODBC will be done e Test Only All outgoing EDI messages will be stamped with Test ISA_15 Records will only be exported to the test environment e Approved All outgoing EDI messages will be stamped with Production ISA_15 Records will be exported to the Live system with ODBC e Type There are five types of trading partners select the necessary one e Providers Hospitals doctors or other health care providers e VANs Value Added Networks like clearing houses or EDI Networks e Service bureaus Third party entities such as repricing organizations e Sponsors Entities that sponsor the benefits of subscribers such as MedicAid government agencies or large employers lt 2013 gt Martin Scholl Consulting Inc 227 HIPAA Authorizer e Payers Entities that pay for health care benefits s
197. rs or for providers The HIPAA Authorizer is uniquely able to deal with this role One scenario is a mental health UMO that contracts with a large payer The payer wants 278 EDI files with the results of those authorizations Providers have to get authorization via this UMO and most likely call or fax in their requests Case workers type the information into the HIPAA Authorizer and adjudicate the authorizations as well After completing a request they can then immediately send the response on to the payer and in case the provider is EDI enabled send it to the provider as well All data elements are stored together with the a record of who adjudicated the authorization Another possibility is that the payer passes on 278 request files to the UMO in order to adjudicate the requests The UMO in turn sends back a 278 response file The HIPAA Authorizer will read and parse the request information into the database Requests can be adjudicated manually or an above mentioned separate process and the HIPAA Authorizer sends the completed 278 response files back HIPAA Authorizer for Providers The HIPAA Authorizer can be employed by providers and hospitals and nursing homes to handle all the authorization related business Clerks can enter authorization requests fast and easy into the HIPAA Authorizer and send them either immediately or in batch mode to the payer The payer adjudicates the request and sends back the response HIPAA Authorizer will display the r
198. rtner this is the status in the above image QA green Thumbs Up means that the request has been accepted A 999 Functional Acknowledgment stating this has been received should be readied the Trading Partner within one hour QA red Thumbs Down means that the request has been rejected This could mean a 999 with a rejection has been received or the response indicated such EJA yellow envelope with a green return arrow indicates that a response has been received A broken chain link indicates that a response was loaded for which the request could not be found You can use the buttons to either create a new request Edit the request that is high lighted View the request in a form and write the request to file and send it to a trading partner Double clicking a line in the workplace grid will pop up a view of the request in a printable form If a response has been received then the response will show Starting a new Request To begin a new request one can either click on the New Request button or use the menu under File gt New Request Then this screen will appear lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 28 a Create Request Requester Info SubscriberPatient Patient Event Level Provider Info Other UMO Service Event Level Requesting Physician Requester Name NM1 Last Organization Name First Name Middle Name Entity Type Address N3 N4 Address City Country
199. s Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request ED Exchange License EDI Exchange License Information Lal F The EDI Exchange Setup menu item 2 The following window will appear EDI Exchange Directory Root Directory Path SMTP Server _ Sender s email address o C Send email notice of newly arrived Files User Name Password Recipients SMTP server requires Logon heise att A Connectto the SMTP server via the SSL protocol Use Port O Validate outgoing files C Reject Incoming Files with more errors than t E set Count below Halt records if EDI compliance E warnings are found O EDI Files with Other Type in Inbox EDI Exchange ts NOT yet initialized i Leave file for other program Auto process if other program is available The EDI Exchange Setup window Note The icon in the lower left corner indicating that EDI Exchange has not been initialized yet 3 After setting the root directory see the previous step Defining Communications lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 28 Directory you can initialize EDI Exchange module Click the Initialize EDI Exchange button to accomplish the process Root Directory Path DIEDN Email Server Infomation Email Notification SMTP Server Sender s email address Fl Send email notice of newly arrived Files User Name Password Recipients O SMTP server requires Logon
200. s the conditions necessitating the oxygen therapy lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 42 Oxygen Therapy Conditions Home Oxygen Therapy Information Conditions requiring Oxygen Therapy The above conditions Apply Do not Apply Oxygen Condition Codes The information in this part of the oxygen screen goes into a CRC segment with the qualifier 11 The second half of the screen is more specific to the home oxygen therapy and equipment lt 2013 gt Martin Scholl Consulting Inc pa HIPAA Authorizer 2 6 7 Oxygen Therapy Conditions Home Oxygen Therapy Information Oxygen Equipment Type 1 Oxygen Eqipment Type 2 Eqipment Reason Description Oxygen Use Blood Gas Oxygen Flow Rate Liters Minute Daily Oxygen Use Count Number of Hours per Use Arterial Blood Gas Qty Description Oxygen Saturation Qty Oxygen Test Oxygen Test Findings 1 to 3 Oxygen Test Condition Portable Oxygen Equipment Portable Oxygen System Flow Rate liter min Oxygen Delivery System Oxygen Equipment Type Home Oxygen Therapy Information Information from here goes into the CR5 segment Available values are in the drop down lists and should be self explanatory for the specialists in this field Functional Limitations Often a request for medical services has to be justified with the patients condition The functional limitation and permitted activities screen serves just this purpose
201. sing Options The options are important for the hand over from EDI Exchange to the other HIPAAsuite program that hosts EDI Exchange Once all verifications have been completed successfully you will see the following message lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 210 Processing Results EDI Exchange initalization started Checking SQL settings and tables Connection settings are checked Trading Pariners table is checked TRANS_LOG table is checked TRANS_LOG ERRORS table ts checked SEND_LOG table is checked COMPANY_SE TUP table is checked COMPANY_ SETUP data is validated Checking for Required Directones Inbox Directory is checked Outbox Directory ts checked Processed Directory is checked Crypt Directory is checked Suspense Directory is checked Checking for EDIDev EdiDev is found EDI Exchange has been successfully initialized and is ready for use Successful initialization of EDI Exchange After that your EDI Exchange is initialized EDI Exchange Directory Setup Root Directory Path DAEDN Browse SMTP Server Sender s email address O Send email notice of newly arrived Files User Name Password Recipients E SMTP server requires Logon ER C Connectto the SMTP server via the SSL protocol Use Port O Validate outgoing files C Reject Incoming Files with more errors than set Count below Halt records if EDI compliance
202. stablish connection to the FTP server Directory FTP Secure FTP C SFTP 4 Once connected the content of the folder on the server is displayed On the right lt 2013 gt Martin Scholl Consulting Inc EDI Exchange 240 side you can browse your local PC 5 To upload a file to the server select the file on your local PC and click on the Put button FTP Client 6 cx 26 DA put E 34_09 edi E test testadi E readme Html The file will appear in the remote folder You will receive the File lt filename gt successfully uploaded message on the bottom status bar of the FTP client Remote FTP Serer Local DAEDMnbox J O My Computer ocr EG DA E SRECYCLE BIN 6 To download a file from the server select a file in the left side and then click on the Get button FTP Client User Password Directo lexample gmailcom leagail ee sy FIP la Secure FTP C SFTP M aG DA SRECYCLE BIN A dvd The file will appear in the local folder You will receive the File lt filename gt successfully lt 2013 gt Martin Scholl Consulting Inc m HIPAA Authorizer downloaded message on the bottom status bar of the FTP client File test_test edi successfully downloaded 10 4 3 Creating a Trading Partner Automatically When you process a file with EDI Exchange the sender s ID is compared to the trading partners on file If the trading part
203. stry if you encounter any problems with saving settings Your administrator might help you Image Files e Output Path for Image Files Define the destination folder where the images will be stored See also Creating Image Files Image Format Choose whether to create PDF or TIFF files e TIFF e PDF Image File Options The following options are available Image Folder Options When you create a lot of images it is important not to place them all in the same folder Microsoft Windows has issues handling more than 1000 files in a folder That is the reason why the HIPAA Claim Payment Master can hash the image files over many sub folders You have the following choice to use e None Default value e Sub folders for Year Month and Day The sub folders will be created within the Image File Location Example 2012 rebruary 29 Desktop 1 My Documents G EDI ASCII Output 3 5 EDI Images Output 5 2012 E May O 29 C EDI Spreadsheet Output The folder structure in Year Month and Day mode lt 2013 gt Martin Scholl Consulting Inc 163 HIPAA Authorizer e Sub folders for Year and Week The sub folders will be created within the Image File Location Example 2012 9 e Sub folders for Year and Day The sub folders will be created within the Image File Location Example 2012 20120229 Color on Images e Choose a color for the form when saving claims to image files You have the choi
204. sulting Inc e HIPAA Authorizer 4 4 1 Responding to Requests Rejecting a Request You can reject a request on a number of levels If you do not have a Trading Partner Relationship with the sender you would reject on the UMO level If your system is down and you cannot answer at the current time you would choose the second option System Level If the provider is unknown to you and you have a policy not to respond to requests from out of network providers you would choose Requester Level If you do not recognize the subscriber or patient or the information is wrong you would answer at the Subscriber or Dependent level If you reject because the service provider is unknown not in your network or the like you would reject at the Provider level Finally you can reject on the service level for example if there is no coverage for the requested services You can have several reasons to reject a request Each time you have to provide three pieces of information Is the request as such valid What is the reason for the rejection What is the action that the requester should take We we press the Reject Request button the following screen comes up lt 2013 gt Martin Scholl Consulting Inc Responding to Requests 90 Loop 20004 System Level O Loop 20104 UMO Level Loop 20108 Requester Level The rejection screen at the System UMO and Requester level Let
205. t will be used to encrypt files for you by your trading partners e Pass Phrase for Private Key Enter passphrase here to decrypt files encrypted previously with the pass phrase Note The keys are identified by the email address of their owner e Crypto Program e GnuPG Select this option if you have already installed the GnuPG software and want to use it Crypto Program E GnuPc C PGP Desktop M GnuPG The configuration using GnuPG Note When you select GnuPG the program checks if the executable gpg exe gpg2 exe is present on your computer If it is not found you will have to specify the path manually or install the program first e PGP Desktop Select this option if you have already installed the PGP Desktop program and want to use it You will see a different lower half of the screen where you can indicate the location of the keys PGP Desktop uses key rings encrypted folders that contain all your keys The location of these two files is very important for PGP Desktop Crypto Pro C GnuPG PGP Desktop Key Rings Publie Private a JE The configuration using PGP Desktop 4 Once the settings are done click the Save button lt 2013 gt Martin Scholl Consulting Inc 29 HIPAA Authorizer The Save button 5 The following notification will appear Click the OK button Records Saved Ca Notification window 10 5 3 Using PG
206. tasks directory looks like this scheduled Tasks File Edit View Favorites Tools Advanced Help a LITA gt E F j Search Folders EE E orporsama nane Address C Scheduled Tasks Schedule Gums Every 2 hour s from 12 00 4M For 00 00PM 2 00 00 4M if Could not start OeO0014 Ad e p E Control Panel i y My Documents A E Es Shared Documents ib Icons By E My Network Places ee Paste ashe St pe n IEE E The Scheduled Task menu item in Windows XP See Running the Application via Scheduler in the help of the host HIPAA application for detailed instructions on how to schedule a task 10 3 4 Using the Command Line Arguments CLI The only EDI Exchange specific command line argument is Auto The Auto processing options are defined in another screen and with the command line argument Auto they will be exercised Make sure that you have configured them according to your needs 10 4 Working with Trading Partners 10 4 1 Setting up Trading Partners With EDI Exchange you can keep track of your trading partners You can set up their identifiers to send them EDI files or 999 acknowledgment send email notifications and compliance check results encryption keys and file transport mechanisms Once you have created the trading partner table see Creating Database Tables and initialized EDI Exchange see Initializing EDI Exchange you can set up the relatio
207. te 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information pr The EDI Send Log menu 2 The following window will appear Specify the time period in which the file was processed Time Period From 8 5 2075 To f 5 2015 Trading Partner Name The EDI Send Log screen lt 2013 gt Martin Scholl Consulting Inc 23 HIPAA Authorizer 3 To display the log data select the time period and a trading partner e Time Period Period of time when the file was processed Choose one of the available options e Receive Date e Load Date e Trading Partner Name Select a trading partner in the list If you select All all trading partners will be included 4 Click on the Find Log Files button to display the list of log files corresponding to your query 10 6 7 Listing SEF Files SEF Standards Exchange Format files are repositories of standards information that define the format of EDI documents SEF files are the basis for the compliance check engine that EDI Exchange uses These files contain all rules of the implementation guide of a transaction There is a SEF file for each transaction that EDI Exchange is licensed for For example for 837 transactions we have SEF files for institutional professional and dental claims in 4010 4010A1 and 5010A1 version and the 997 and 999 transactions
208. ted path You can change this path by changing the EDI Root Directory e Trading Partner s Repository Mandatory setting Click on the three dots button to access the Select Folder window There you choose an existing folder or create a new one Once you have specified the directory settings click on the Create Folders Using Trading Partner ID Local Directory Settings EDI Identifiers Options Remote FTP Contact Encryption Folders CORE Outgoing Files Root Trading Partner s Outbox DAEDNOutbox TXEBS a Processed Files Root Trading Partner s Repository DAEDNProcessedFiles TXEBS a Ale Naming Convention CMS The Create Folders Using Trading Partner ID button e File Naming Convention Health Insurance Exchanges HIX demand that a carrier adheres to more or less complex File naming conventions Since these conventions are often really complicated we decided to hard code several schemes California lt 2013 gt Martin Scholl Consulting Inc 235 HIPAA Authorizer Maryland DC and the CMS scheme are currently configured and we will add other schemes if needed CORE Tab This tab stores settings for the use of CORE Compliant SOAP and MIME enveloped transactions When using a Requester or similar application these settings apply to the information source When using a Responder or similar application these settings apply to the information requester receiver EDI Identi
209. tem maybe the system is down All those and many conditions are expressed in so lt 2013 gt Martin Scholl Consulting Inc e HIPAA Authorizer 3 4 called AAA segments In these segments we find the coded information on the rejection Viewing Subscriber or Patient Information The picture below shows the subscriber patient information Requester Info Subscriber Patient Patient Event Level Provider Info Other UMO Service Event Level Patient Information Subscriber Relationship INS Subscriber Name NM1 a Last Name First Middle Sufix Subscriber is a patient SMITH JOE Employment Status ID Type ID AQ Active Military Overseas MI Member ID Number 12345678901 Address N3 N4 Address PO BOXSUB 171021 TEST ADDRESS City state Zip Country Code Subdivision KANSAS CITY MO Missouri 64108 Additional Identifiers REF ID Qualifier ID Code ID Type SY Social Security Number 123456789 ID Code Demographic Information DMG DOB 03 22 1958 Sex M Male Health Information Accident Date Onset of Symptoms Event Date Admission Date Discharge Date Last Menstrual Estimated Birth 04 30 2005 04 15 2005 05 16 2005 05 05 2005 05 09 2005 03 12 2005 11 30 2005 Diagnosis Type Diagnosis Diagnosis Date i BF Diagnosis ICD 3 CM 141090 04 15 2005 Subscriber and Patient tab This tab displays information on the patient who might be the subscriber or a dependent If patient and subscriber are the same person yo
210. the Add Provider Info button to add the information to the request Only when you see the provider in the grid on top of the form will it be in the transaction 2 8 Other UMO Authorizations and review requests can be denied and the requester be it a patient or provider can ask for a reconsideration or a second opinion But in order to convey previous denials there is a screen where the other UMO s that denied the request earlier are entered lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer 2 9 2 9 1 Other UMO Type Name Denial Reason Denial Date Other UMO Information Other UMO Type Denial Date A l Er Add Other UMO Info UMO Name Main Denial Reason Additional Denial Reasons The Other UMO screen The information consists of the name of the UMO and up to 4 denial reasons and a denial date Up to three other UMO can be listed Note that you have to click on the Add Other UMO Info button to add the information to the request Only when you see the UMO in the top grid will it be in the transaction Loop 2010EC contains this information Service Event Level Service Detail The information in the service detail loops is not required A simple authorization request does not need to have service detail information in it and your trading partner should tell you in the beginning when you set up the relationship whether they want detail information and to what extent In the database the detail information is
211. tical to the one on the patient event level lt 2013 gt Martin Scholl Consulting Inc 53 HIPAA Authorizer 2 10 Review Info Professional Institutional Dental Delivery Paperwork Msg Provider E MN 410 of 0 Service Line Providers bb cp X Provider Type Name ID Type Provider ID Provider Information Last Name First Name Middle Name Provider Type ID Type 1 Address City State dp Contact Phone _ Extension Fasi Email URL Provider Code Specialty pm ID Qualifier ID Code License No State Code Save Provider into DB Save Provider Info The provider screen on the detail level While the 5010 standard allows up to 10 Service Detail Level providers the HIPAA Authorizer limits this to up to 3 providers that can be added Again note that you have to click Save Provider Info to have the information actually added to the transaction You can navigate through the providers by using the navigation bar above the provider grid Saving a request Once we create a complete request we can save the transaction to the database Here several things happen e Each screen is individually verified for required information If elements are missing a message pops up with information as to what is missing e The record cannot be saved unless all those error messages are dealt with e Secondly a HIPAA compliance check is performed on the saved record if
212. tional Paperwork Msg Provider Text Message Paper Work Report Type Transmission Control Number Descnption Add Contact For Paperwork The Messages and Accompanying Paperwork Window For the response you can add your own free form text and also put in a request for additional information and supporting paperwork The drop down menu boxes will allow you to select a report type and transmission method according to the specification in the 278 transaction set You can add several lines of report requests here If you click on the Add Contact For Paperwork button the following screen appears lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 86 Request for additional patient information Contact Name Send Requested Paperwork to the Following Contact and Address Name First ID Type Address Address City Contact Fax Adding contact information for the delivery of Paperwork 3 8 7 Service Line Providers Just as on the Patient Event Level we can have provider information on the service line level Imagine a hospital asking for authorization for an operation The Anesthetist could occupy one service line with his procedure and provider information while an assistant surgeon will be entered on another line The HIPAA Authorizer allows for 3 line level provider for each line When we click on the Provider tab we see the following screen lt
213. tor a Ed Information 7 Ms ServiceDate E RequestorEntityiD iM ServiceEndDate Y RequestorName E F Service Codes W RequestorFirstName teM ProcedureCodeType 1 ProcedureCode W Modifiert W Modifier 9 Modifier3 W Modifier4 The field selection screen After you select the fields you must test the configuration before you can save the fields If you do not have a selected field in your database you will see an error screen come up 5 5 Field Errors If fields don t exist in the database that you specified you will see an error screen lt 2013 gt Martin Scholl Consulting Inc 105 HIPAA Authorizer a SOL Errors Table ED _PremiumPayments Invalid column name Tota Invalid column name Effective Invalid column name SenderAccounts Invalid column name PaymentsMethod The error screen you will see if the field selection contains non existing fields Study the errors in detail and see what went wrong In this case for demonstration purposes changed a few field names and of course that caused this error My best option is to click the Uncheck the Fields in Error button and return to the field selection screen helds to be exported Header Table TradingPartnerlD 2 TransactionNo Filename 2 HandlingCode Tota Amount Effective Date F SenderAccounts 4 ReceiverAccount Payments Method 4 MasterAccount Cover
214. try When you type in the Name or Id field you will be confronted with previously entered patients and subscribers a Lreate AUTNOTIZAT Requester Info Subscnber Pat Patient Information Subscriber When you select the record the information is filled in lt 2013 gt Martin Scholl Consulting Inc 35 HIPAA Authorizer 2 6 2 6 1 Subscriber Last Name DOE ID Type D MI Member ID Number 3258579 Address C Subscriber is a patient City state Additional Identifiers ID Qualifier ID Code HJ Identity Card Number 1G Insurance Policy Number DOE 31246 D863 7342 D0E Patient Event Level Review Request Screen Additional Patient Information First Middle Suffix JOHN J Ill DOB Sex Employment Status i 10 10 1960 M Male RU Retired Military USA Zip Country Code Subdivision ID Type ID Code 7 Save Subscriber into Database The third main tab is call Specialty Review and contains quite a few sub screens First when we click on this tab we see the following screen lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 36 Requester Info Subscriber Patient Patient Event Level Provider Info Other UMO Service Event Level Review Delivery Ambulance Chiropractor DME Oxygen Actvites Limitatons Health Care Services Review Information UM Request Category Certification Type Bill Type Service Type Related Causes Acci
215. tup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information lt 2013 gt Martin Scholl Consulting Inc 203 HIPAA Authorizer The Autoprocess Setup menu item 2 The following screen will appear if the host HIPAA application is Enrollment Master Automatic Processing Options Get Ales from Trading Partners C Check FTP servers for new files and place them into Inbox Default Automatic Processing Options L Export in Database E Print Saveto image E Excel E ASCII Defining the Auto Processing Options 3 The following options can be specified Check Path Options e Check FTP servers for new files If checked EDI Exchange automatically looks for new files for all trading partners that have FTP connection set up Then the program gets all the waiting files and puts them into the Inbox In the second step it goes through every file Default Automatic Processing Options e Export in Database If selected the module exports new files to the database e Print If selected the module prints files using the selected printer e Create Auto Response If selected the module creates an auto response to the received files e Save to If selected the system automatically saves files as e Image e Excel e ASCII 4 Click Save lt 2013 gt Martin Scholl Consulti
216. u will only see one tab if there is a separate patient you will see a Patient tab Underneath the demographic information are request specific dates and the diagnosis specific information These fields are not editable It is information that came in the request The tab Additional Patient Information tab contains fields that can be edited and looks like this lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 66 Subscriber Additional Patient Information Text Message THIS IS AFREE FORM TEXT MESSAGE Paper Work Report Type Transmission Control Number Description Reject at Patient Event Level Add Contact For Paperwork The tab for additional information A free form text message that came with the request will be displayed here or the adjudicator can add text here for the response In the same way is it possible to require additional paperwork The drop down menu boxes will allow you to select a report type and transmission method according to the specification in the 278 transaction set You can add several lines of report requests here You can even specify to which address the documentation will be sent lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer Request for additional patient information Contact Name Send Requested Paperwork to the Following Contact and Address Name First ID Type Address Address 2 City Contact Fax Adding
217. uall varchar 3 NULL DependentOtherlD1 varchar 30 NULL DependentOther DQual2 varchar 3 NULL DependentOtherlD2 varchar 30 NULL DependentOtherlDQual3 varchar 3 NULL DependentOtherlD3 varchar 30 NULL DependentAddress1 varchar 55 NULL DependentAddress2 varchar 55 NULL DependentCity varchar 30 NULL DependentState char 2 NULL DependentZip varchar 15 NULL DependentCountry varchar 3 NULL DependentSubdivision varchar 3 NULL DependentSex char 2 NULL lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer DependentBirthDate date NULL Dependent_RejectReason1 char 2 NULL Dependent_FollowUpCode1 char 1 NULL Dependent_RejectReason2 char 2 NULL Dependent_FollowUpCode2 char 1 NULL Dependent_RejectReason3 char 2 NULL Dependent_FollowUpCode3 char 1 NULL Dependent_RejectReason4 char 2 NULL Dependent_FollowUpCode4 char 1 NULL Dependent_RejectReason5 char 2 NULL Dependent_FollowUpCode5 char 1 NULL Dependent_RejectReason6 char 2 NULL Dependent_FollowUpCode6 char 1 NULL Dependent_RejectReason7 char 2 NULL Dependent_FollowUpCode7 char 1 NULL Dependent_RejectReason8 char 2 NULL Dependent_FollowUpCode8 char 1 NULL Dependent_RejectReason9 char 2 NULL Dependent_FollowUpCode9 char 1 NULL TRN TraceOriginator varchar 30 NULL
218. uch as health insurers The next block on the form lists the communication methods and preferences e EDI File Exchange Method Obligatory setting HIPAAsuite supports three communication methods Choose a preferred mode of sending EDI communications to the trading partner e FTP Allows you to transmit files actively to the Trading Partner or his Clearinghouse e Outbox All files for Trading Partner are stored locally The Trading Partner is responsible for picking up files in his special directory of the local FTP or HTTP server e Email Addresses Enter the email address es into the text field EDI Identifiers Tab This tab relates to the EDI identifiers and EDI Version EDI Identifiers Options Remote FTP Contact Encryption Folders CORE EDI Identifiers and Qualifier was oe EDI Version ISA Identifier and Qualifier Record Key i k 4010 5010 ETIN Number and Qualifier Application Sender Code GS02 to use Application Receiver Code 6503 to use Trading Partner Assigned ID a CCHMP The EDI Identifiers tab e EDI Version There are two standards for HIPAA e 4010 This standard was introduced in the original transaction from 2003 to 2011 e 5010 From 2012 on all HIPAA transactions must be conducted in the 5010 version e EDI Identifiers and Qualifier e ISA Identifier and Qualifier Record Key The ISA Identifier and Qualifier are the unique key to the trading partner database
219. very Pattern Delivery Pattern Time SA Wednesday and Thursday D AM lt 2013 gt Martin Scholl Consulting Inc 39 HIPAA Authorizer 2 6 3 Ambulance Service The tab for ambulance review is quite complex Several segment flow into this Review Delivery Ambulance Chiropractor DME Oxygen Activities Limitations Mental Status Home Health Ambulance Conditions The above conditions Apply O Do not Apply Ambulance Transport Information Weight Unit Ambulance Transport Code Description of Trip Purpose Distance Unit Ambulance Transport Reason Justification for Stretcher Use Transport Locations Pick up Location Drop off Location Final scheduled Destination Next Destination Next Scheduled Destination Name Address State The Ambulance tab On top we have the ambulance conditions from the CRC 07 segments Here are descriptors for the patient s condition that justify the use of an ambulance Next is the ambulance transport information that goes into the CR1 segment and lastly are 5 locations that are connected to ambulance service such as pick up and drop off from the loop 2010EB 2 6 4 Chiropractic Services The Chiropractor tab has the necessary information to request the care of a chiropractor lt 2013 gt Martin Scholl Consulting Inc Creating Authorization Requests 40 Review Delivery Ambulance Chiropractor DME Oxygen Activities Limitations Mental Status Home He
220. wo of them require an explanation Load for Editing When you click this button the selected records are then transferred into the grid of the request main window and served in the work place Create 278 EDI The query is passed into the from from which you can create a 278 file Create 278 files The HIPAA Authorizer can create 278 EDI files from database records All the complex logic of building the loops and nestings is done by the software The database could be populated by loading 278 EDI files or creating a process of automatic authorization that fills in fields in the database with the response and then the response file will be created and sent to a trading partner Considerable interface work will be necessary and we at HIPAAsuite will help you in the design and all necessary customizations on our side lt 2013 gt Martin Scholl Consulting Inc Working with stored requests 152 There is a manual process where you can enter a database query and end up with the 278 file created but it can also be done via command line arguments When you click the Create 278 button in the Stored Authorization Request screen you will see the following screen m Create 278 TransactionSets E le x 1 SELECT TOP 20 FROM EDI_AuthorizerHeader ia Effective Date 7 9 29 2014 Fields with will be populated by the process Exit Go Select Trading Partner Help ISA segment Password 1D
221. written to file have been sent to a trading partner who is supposed to receive them or whether a response has been received Right clicking the workplace grid is a quick way to access any of these functions for a selected record In Request Mode we have two initial options when the form loads we can work with the database if it is licensed or we can work from files and load previously created 278 requests These requests could conceivably be created with other applications Or of course we can start with a clean slate and create new request from scratch Work with File Database m The options to load requests either from file or from the database Below the workplace grid you see three check marks with conditions that control what and if records are shown in the grid 1 Limit the quantity or requests that are displayed per page lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer 2 2 2 Show records based on a date range 3 Show only records which are not sent yet The query settings naturally apply only when we work with the database The last column contains an image representing the status of the request YA green check mark means that the request is HIPAA compliant and saved SA red circle with a bar through it indicates that the record has not passed the compliance check SA red envelope means that the send process failed A blue envelope signifies that the request was successfully sent to the trading pa
222. y 4010 e 4010 if in original otherwise 5010 e only 5010 Contact Information The contact information goes into the PER segment of outgoing transactions e Contact Person e Telephone e Ext e Fax e E mail ISA 14 and 15 e EDI files will be ISA element 14 determines if the resultant file contains test or production data lt 2013 gt Martin Scholl Consulting Inc The HIPAA Authorizer 16 e Test e Production e Acknowledgement TA1 req ISA element 15 indicates whether you want a TA1 acknowledgement for files that you send out 1 6 Edit Mode Setup Here we can determine the behavior of the Create Edit screens Edit Mode Setup Auto generated TRN Trace Assigning Entity Identifier TRNOS 1521385200 Turn off Auto Complete for Requester Subscriber and Provider names Turn off Auto Complete for Requester Subscriber and Provider ID s Create and Edit Requests E Check requests on compliance while saving Save Close The Edit Mode Setup screen The first element is the Entity identifier that is used in the TRN_03 element Since it will be the same for all requests it can be set here Next comes the auto complete behavior If you save requesters subscribers and providers they will be available for auto complete action unless you select here not to have the auto complete feature Last is the option to check the requests for HIPAA EDI compliance We feel that this is very important whe
223. your own system We recommend that you establish these two tables and process from these staging tables the data into your system and apply your business rules Once you have the data in a format that is legible to your specific system and experts you can easily work from those tables 5 2 Setting up an ODBC Connection ODBC connection are established in the Windows Control Panel with newer versions having the ODBC Data Source Setup under the Administrative Tools Start gt Control Panel lt 2013 gt Martin Scholl Consulting Inc 4 Control Panel Adjust your computer s settings System and Security Review your computer s status Back up your computer Find and fix problems Network and Internet View network status and tasks Choose homegroup and sharing options Hardware and Sound View devices and printers Add a device Programs Uninstall a program s HIPAA Authorizer Search Control Pane View by Category User Accounts and Family Safety a Add or remove user accounts Set up parental controls for any user Appearance and Personalization Change the theme Change desktop background Adjust screen resolution Clock Language and Region Change keyboards or other input methods Ease of Access Let Windows suggest settings Optimize visual display The Windows Control Panel in Vista and later version find the easiest way to find anything in the control panel is to search for it s
224. ype Initial Service Type Consultation Facility Type Hospital Inpatient Including Medicare Part A Bill Type UB claim form Release ofinfornation Yes Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim Authorization Number A123 Administrators Reference Number 125 Accident 04 30 2005 Last Menstrual Period 03 12 2005 Estimated Date of Birth 11 30 2005 Onsetof Current Symptoms or Illness 04 15 2005 Event 05 16 2005 Admission 05 05 2005 Discharge 05 09 2005 Message Text This is a free form text message Diagnosis Codes Diagnosis ICD 9 CM 41090 Date 04 15 2005 Health Care Services Delivery 1 Visit s perevery 1Day s for 10 Day Ambulance Certification The following Condition s applied Patient was admitted to a hospital The form to view a 278 Authorization request All cryptic codes are translated and the information is grouped by the segments in which it is contained This form is printable and can even saved as TIFF or PDF file lt 2013 gt Martin Scholl Consulting Inc Response Mode Viewing Requests 64 3 3 Viewing Records in Edit Screens When we click on Start Responses we see the same screen that is used to manually enter a request The only difference is that most fields are disabled and only those that can be edited for the response are enabled a Create Response l Requester Info Subscriber Patient Patient Event Level Provider Info Other
225. zation Request Counter Payer Subscriber ID Authorization EMBLEM HEALTH MORENA BLANCA 20638162 No Certification required Manual Process a Save Requests to Database EMBLEM HEALTH GODLIZIA GENNE 20638174 No Certification required EMBLEM HEALTH PEREZINO ALGENDRO 20638160 No Certification required EMBLEM HEALTH LUKOWITS EMREN 20638159 No Certification required EMBLEM HEALTH MACEN REN 20638163 No Certification required EMBLEM HEALTH CALIDO KENNY 20638168 No Certification required C Data Export C Show on screen C Print C Image File s Process 5 Run with compliance check Wiew Request Start Responses Create Response File View Report Move Processed File View ED File No update available The main screen in response mode All the requests are loaded into the workplace grid and can be processed one by one 1 2 Software Trial The HIPAA Authorizer comes with a free trial of 14 days Should your trial time expire and you wish to continue your testing of the software please send an email to info HIPAAsuite com with the Registration number and we will give you a trial extension lt 2013 gt Martin Scholl Consulting Inc HIPAA Authorizer If the product is not registered and you start it you will see first the trial screen a License HIPAA Authorizer 40 Day s remaining for trial 15 This is a fully functional evaluation You are free to evaluate this de

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