Wednesday, November 6, 2013

The ASC X12 834 005010X220/005010X220A1 Lonesome Highway Blues

Enrollment numbers may be stuck in computer limbo, health IT consultant says
By Joseph Conn

Federal officials are tight-lipped on enrollment numbers from the troubled website.

That's probably because applications are caught in a limbo of computer-generated inaccuracies, according to a health IT consultant who worked on two of the insurance exchanges not run by HHS.

“The definition of enrollment in my mind is someone who has actually been set up in the health plan and they've confirmed that back to the exchange,” said Stuart Beaton, a Nashville-based consultant. “Once that confirmation has been received by the exchange, that's when you're enrolled. And the federal exchange and some of the states are having trouble with that round-trip exchange.”... “has not been able to correctly put the members in the enrollment file in the right way,” Beaton said. “And until those corrected fields are sent back to the insurance company, they're not enrolled. So, I think there are number of people in that limbo state, and their corrected information has not been sent back to they exchange.”

The considerable complexity of family relationships and a lack of adequate testing of the system before its launch are roots of the problem, according to Beaton.

“The logic was confused, and the (ASC X12) 834 (enrollment transaction) just reflected what (data) was [sic] passed to it,” Beaton said...
Centers for Medicare & Medicaid Services (CMS)
Instructions related to the ASC X12 Benefit Enrollment and Maintenance (834) transaction, based on the 005010X220 Implementation Guide and its associated 005010X220A1 addenda for the Federally facilitated Exchange (FFE)

On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act (P.L. 111-148). On March 30, 2010, the President signed into law the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). The two laws are collectively referred to as the Affordable Care Act (ACA). The ACA creates new competitive private health insurance markets – called Health Insurance Exchanges (Exchanges) – that provide millions of Americans and small businesses access to affordable coverage and the same insurance choices as members of Congress. Exchanges help individuals and small employers shop for, select, and enroll in high quality, affordable private health plans that fit their needs at competitive prices.

The Act and subsequent Rule outline the standards to be used between the Exchange and covered entities. The Exchange is required to use the standards, implementation specifications, operating rules, and code sets adopted by the Secretary in 45 CFR parts 160 and 162. Further, the Exchange is required to incorporate interoperable and secure standards and protocols developed by the Secretary in accordance with section 3021 of the Public Health Service (PHS) Act.

This companion guide contains detailed information about how the Federally facilitated Exchanges (FFE) will use the ASC X12 Benefit Enrollment and Maintenance (834) transaction, based on the 005010X220 Implementation Guide and its associated 005010X220A1 addenda...

Gonna be interesting to see whether they can surmount these issues in the next 24 days.

And, more neat-o Health IT fun looms quietly ahead, too, for both PPACA and Meaningful Use Stage 2 and beyond. Add in to that the upcoming ICD-10 conversion deadline next October, jeesh. Here's a little taste of ASC X12 275:

Purpose and Business Overview

For the health care industry to achieve the potential administrative cost savings associated with Electronic Data Interchange (EDI), standards have been developed and need to be implemented consistently by all organizations. To facilitate a smooth transition into the EDI environment, uniform implementation is critical.

The purpose of this implementation guide is to provide standardized data requirements and content to all users of ANSI ASC X12 275 Patient Information (275) Transaction Set. This Implementation guide focuses on the use of the 275 to send additional information about a claim or encounter. This implementation guide provides a detailed explanation of the transaction set by defining uniform data content, identifying valid code tables, and specifying values applicable for the business use of conveying Additional Information to Support a Health Care Claim or Encounter (275). The intention of the developers of the 275 is represented in the guide.

This implementation guide describes a solution that includes the encapsulation of a Health Level Seven (HL7) Standard within the 275 transaction. HL7 is an ANSI Accredited Standards Development Organization (SDO) whose domain is clinical and administrative data. HL7’s mission is: “To provide standards for the ex- change, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services. Specifically, to create flexible, cost effective approaches, standards, guidelines, methodologies, and related services for interoperability between healthcare information systems”.

HL7 is widely used in the United States as well as many other countries. For the purpose of this recommendation, the HL7 ANSI approved standard being proposed is the Clinical Document Architecture (CDA), as tailored for Claims Attachments. CDA is a standard that expresses data using Extensible Markup Language (XML).

This implementation guide is designed to assist those who send additional supporting information or who receive additional supporting information to a claim or encounter using the 275 format.

Entities that use this implementation of the 275 include but are not limited to, Health Plans, third party administrators (TPAs), managed care service organizations, state and federal agencies and their contractors, plan purchasers, and any other entity that processes health care claims, manages the delivery of health care services, or collects health care data. Other business partners affiliated with the 275 include but are not limited to billing services; consulting services, vendors of systems, software and EDI translators, and EDI network intermediaries such as Automated Clearing Houses (ACHs), Value Added Networks (VANs), and telecommunications services...
 The Standards Promulgation Industry is out there hard at work generating ever more byzantine layers of complexity. I count at least a dozen ASC X12N standards coming to bear on healthcare related EDI (148, 269, 270, 271, 274, 275, 276, 277, 278, 834, 835, and 837).


This hearing got rather heated at times. Senator Roberts again loudly asked for her resignation. Senator Hatch sees the Ominous Single Payer Boogeyman lurking within every subsection of the PPACA.

Ms. Sebelius mostly gave as good as she got, but it's obvious that she's got her neck on the line. I watched all of it. It was wearing.


Unsolicited shout-out. Just got a new twitter follower.

About Us was launched in May 2009 by Gwen Darling, the former General Manager of  In her role as manager of the previous job board, Ms. Darling formed relationships with hundreds of Healthcare IT employers, and thousands of Healthcare IT job seekers, many of whom expressed their desire for a more robust, comprehensive Healthcare IT industry Career Center.  A new site featuring rich Healthcare IT career content, expanded candidate resources, and enhanced employer tools grew out of these discussions and requests. offers a level of  service you just can't get with the larger, impersonal "one size fits all" job boards.
Check 'em out. Irrespective of any outcomes of the continuing DC Clown Car Show, the health care space will remain the hottest employment opportunity domain in the nation. One with the greatest opportunities for improvement (my particular interest) as well.


I guess I'm gonna have to bite the bullet and buy a subscription. Their good stuff is usually firewalled.

Hackers' Attacks on Banks Take Advantage of Confusion
by PENNY CROSMANNOV 11, 2013 11:22am 

While distributed denial of service attacks ebb and flow based on geopolitics, mortgage problems and earnings reports, the two leading types of cyber threats on banks of late are two types of phishing. One plays off the government's troubled healthcare program, the other spoofs top executives' email accounts, according to Christopher Novak, managing principal and security expert at Verizon Business.

"A lot of social engineering campaigns are using the confusion around what's happening in healthcare to say, you need to come to this website and register and give up either personal information or credentials," Novak says. The victim thinks it's a legitimate message from the company for which he works and coughs up the desired credentials on a fake website.

The emails say something like, you've probably heard in the media that there's this new healthcare regulation taking effect, you need to re-sign up for open enrollment, come in through Bank X's website.

"In reality, it's a hacker hosted site," Novak says. "You're supposed to log in with your bank credentials." Minutes after the victim enters his credentials on the website, someone will come in from Asia or Eastern Europe and use that login information on the bank's website. The hacker will then conduct a funds transfer or ACH transaction to move money out of the account.

"It's a different twist on something we've seen before in phishing," Novak says. "There's a lot of talk, a lot of confusion, a lot of information and misinformation about healthcare right now. Those are the kinds of things the hacker community loves. That's why every March and April you see a whole set of phishing emails that go out around taxes."...

More to come...

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