Are you ready to do something about standardizing health care ecommerce? If yes, continue. What is it? Something as basic in American health care as a claim and a payment ought to be standardized. The government has decreed it. Historically, the health care industry lagged behind others in its use of electronic commerce, but now the focus is on implementing HIPAA. This book explains how to do that implementation properly and covers the nuts and bolts from data fields filled with codes to multi-billion dollar financial analyses of industry-wide savings.
The costs and benefits of compliance show that long-term benefits are profound but that initially costs outweigh benefits. This makes for a challenge to achieve compliance that this book is intended to help overcome.
The standards are explained from the X12 envelopes through the codes and identifiers. Translators are the tool for translating between a non-standard transaction and a standard one. They support gap analysis and require testing. The compliance life cycle include an analysis of the business situation. A spreadsheet is provided to help determine whether to rely on clearinghouses to handle transactions or install a translator. Large entities are more likely than small entities to install a translator. Case studies enliven this transaction compliance manual.
What is it not?
The book focuses on provider-payer transactions, although it includes a chapter with supply chains and web-based patient records. The impact of HIPAA will spread to supply-chain and patient ecommerce and relates to ecommerce in all industries. HIPAA requires that privacy and security accompany the standardizing of transactions. HIPAA privacy and security are major subjects that are extensively covered elsewhere and will not be addressed in this book.
Who should read this?
This book can serve anyone interested in ecommerce but particularly addresses those who have health care ecommerce responsibility. Information systems, financial, and operational professionals are the top three because they are most involved in transactions. The material assumes no particular background of the audience. However, maturity is assumed in terms of understanding both health care and information systems.
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