[ebxml-cppa] WEDi/SNIP Electronic Trading Partner Agreements for HIPAA

["William J. Kammerer" <wkammerer@novannet.com>]

The WEDi/SNIP ID & Routing group, a Special Interest Group under the
Business Issues Sub-working Group of the WEDI HIPAA SNIP Task Group, at
http://snip.wedi.org/, is developing recommendations for the
"auto-discovery" of trading partners (payers, providers, third-party
administrators, etc.) and their technical capabilities.  We plan to
devise an Electronic Trading Partner Agreement (e-TPA) which can be
located by Trading Partner ID of any participant involved in HIPAA
Health Care EDI - either through a DNS-based "directory" of our own
design, or possibly UDDI or the OASIS ebXML Registry.

Enacted in August 1996, the Health Insurance Portability and
Accountability Act (HIPAA) is a U.S. federal law which is intended to
improve the availability and portability of health coverage and to
reduce the costs and administrative burdens of healthcare through the
use of standardized Electronic Data Interchange (EDI). Toward that end,
the legislation requires payers, clearinghouses and providers to
standardize electronic transactions in a confidential and secure
environment within two years following the publication of the final
rules.

In summary, pretty much all health care insurance companies and large
providers (such as hospitals) are under the gun to meet an October 2003
deadline for being able to do the "business" side of health care using
ANSI ASC X12 EDI.  This includes supporting electronic Claims, Claims
Status, Payments, Eligibility Benefit inquiries, and Service Reviews.
HIPAA EDI is the "Y2K problem" of the U.S. health care industry - though
its implementation deadline has now been extended twice!

We would like to use as much as possible from the OASIS ebXML CPP for
developing our e-TPA.  We already know that many HIPAA scenarios involve
"legacy" (e.g., non-Internet) protocols and packaging (e.g., EDIINT or
straight unadulterated EDI).  Even if you can't help us out with the
imminent (within the year) needs of the Healthcare community, we would
still want our own e-TPA to have as much compatibility as possible with
whatever is going on in ebXML.  Dick Brooks participates both in the
WEDi/SNIP ID & Routing group and in ebXML, and will serve as our liaison
to the OASIS CPPA TC.

We already suspect that directly supporting "legacy" protocols and
packaging would probably entail changes beyond the CPP-CPA 2.0 version.
Considering that HIPAA potentially covers hundreds of thousands of
health care providers and thousands of payers (including the U.S. Dept.
of HHS Medicare), and could make the U.S. Healthcare the first real
beneficiary of Open-EDI, it stands to reason this is a great opportunity
to make the CPPA more widely applicable.  We trust that our proposal to
work together in extending the CPP is well-received by this Technical
Committee - even if HIPAA payloads themselves are stinky old X12 EDI!

Please see http://www.novannet.com/wedi/ for more information on the
WEDi/SNIP ID & Routing group, including our listserve archives.

William J. Kammerer
Novannet, LLC.
+1 (614) 487-0320