We use cookies and other similar technologies (Cookies) to enhance your experience and to provide you with relevant content and ads. By using our website, you are agreeing to the use of Cookies. You can change your settings at any time. Cookie Policy.

Part 1: Executive Summary

This report examines the impact that the Healthcare Insurance Portability and Accountability Act (HIPAA) will have on the electronic commerce initiatives of healthcare providers and payers (insurance companies and healthcare maintenance organizations) striving to comply with new IT requirements taking effect on October 16, 2002.

There is much more than meets the eye in meeting the requirements of HIPAA. While many organizations in healthcare are anticipating a simple software adjustment to their communications applications, it is now becoming increasingly clear that, in addition to adopting national e-business standards like ANSI ASC X12 transaction sets, HIPAA compliance will also require a significant amount of work on internal enterprise applications.

This report concludes that both the healthcare community and the information technology vendors that support it will need to undertake a significant amount of preparation and education in order to ensure compliance by the HIPAA deadline.

The IT departments of healthcare companies in the United States face an acronym-imposed deadline for the second time in nearly two years, and the consequences of HIPAA may be more far-reaching than Y2K. The reason: where Y2K required organizations to identify and remedy programming code--a labor-intensive but operationally straightforward challenge--HIPAA mandates that by October 16, 2002, healthcare organizations adopt national standards for electronically processing administrative and financial transactions.

The new standards requirements will redefine the exchange of data behind a wide range of healthcare transactions, including:

  • Eligibility
  • Coverage
  • Benefit inquiries
  • Benefit information
  • Healthcare claim status requests and notifications
  • Healthcare services review information
  • Payment/order remittance advice
  • Benefit enrollment
  • Healthcare claim payment/advice

Beyond changing the business applications that healthcare providers and payers currently use to comply with voluntary national standards, it is increasingly clear that many organizations will have to adjust their business conventions--the way they actually operate--to comply with the HIPAA mandate.

For instance, HIPAA will require use of American National Standards Institute's (ANSI's) Accredited Standards Committee (ASC) X12 electronic data interchange (EDI) syntax. The X12 997 Functional Acknowledgment transaction set will be required to identify receipt and accept or reject a transaction based on whether or not transmission conforms to the syntax. But it will also require the X12 824 Application Advice transaction set to report application-level errors to the sending party. In other words, the HIPAA requirement dictates how the transaction set should be processed by the application after it has been translated.


1  2  3  4  5  

   Next Page

Explore Our Topics

  • Virtual Conferences
  • Webinars
  • Roundtables

BPM in Action

March 10, 2011

The sixth annual BPM in Action 2011 Virtual Conference will explore cutting-edge market developments in BPM and describe how to leverage them for improved business operation and performance. More

View All Virtual Conferences

Smart Case Management: Why It's So Smart.

Date:Nov 05, 2009
Time:12:00 PM ET- (17:00 GMT)


Date:Oct 29, 2009
Time:15:00 PM ET- (19:00 GMT)

View All Roundtables
  • Research Library
  • Podcasts
  • News

Joe McKendrick: Part II of II: Designing Evolve-ability into SOA and IT Systems

In part two of Joe McKendrick's recent podcast with Miko Matsumura, chief strategist for Software AG, they talk about how SOA and IT systems need to change and grow and adapt with the organization around it.

Listen Now

Phil Wainewright: Helping Brands Engage with Social Media

Phil Wainewright interviews David Vap, VP of products at RightNow Technologies, and finds out how sharing best practices can help businesses understand how best to engage with online communities.

Listen Now

Peter Schooff: Making Every IT Dollar Result in a Desired Business Outcome: Scott Hebner of IBM Rati

Scott Hebner, Vice President of Marketing and Strategy for IBM Rational, discusses a topic on the top of every company's mind today: getting the most from IT investments.

Listen Now

Jessica Ann Mola: Where Will BI Fit In? Lyndsay Wise Explains

In BI, this tough economy and the increasing role of Web 2.0 and MDM are certainly topics on people's minds today. WiseAnalytics' Lyndsay Wise addresses each of them in this informative podcast.

Listen Now

Dennis Byron: Talking with...Deepak Singh of BPM Provider Adeptia

Deepak Singh, President and CTO of Adeptia, joins ebizQ's Dennis Byron in a podcast that gets its hand around the trend of industry-specific BPM.

Listen Now
More Podcasts
  • Most Popular
  • Quick Guide
  • Most Discussed

Quick Guide: What is BPM?

Learn More

Quick Guide: What is Event Processing?

Smart event processing can help your company run smarter and faster. This comprehensive guide helps you research the basics of complex event processing (CEP) and learn how to get started on the right foot with your CEP project using EDA, RFID, SOA, SCADA and other relevant technologies. Learn More

Quick Guide: What is Enterprise 2.0?

A lot of people are talking about Enterprise 2.0 as being the business application of Web 2.0 technology. However, there's still some debate on exactly what this technology entails, how it applies to today's business models, and which components bring true value. Some use the term Enterprise 2.0 exclusively to describe the use of social networking technologies in the enterprise, while others use it to describe a web economy platform, or the technological framework behind such a platform. Still others say that Enterprise 2.0 is all of these things. Learn More