Health Information Compliance Alert

Published on Thu Jan 03, 2013 PDF

Software providers appear to be on track to meet the October 2002 deadline for compliance with the Transactions and Code Sets rule. A recent survey by the Healthcare Information and Management Systems Society examined 25 leading healthcare software products, which together account for nearly 4,700 installations in a range of industry segments.

Vendors were asked to identify which of the nine electronic transactions established by the TCS rule would be supported by their products in the required X12 Format 4010 version.

Notable findings include:

• The three most widely supported transactionswere Healthcare Claims — Professional (X12837 P), Eligibility Benefit Inquiry and Response(X12 270/271), and Payment and Remittance Advice(X12 835). Each of these will be supported by24 of the 25 products surveyed. The HealthcareClaims — Institutional transaction (X12 837 I) wassupported by 23 products; the Claim Status Requestand Response transaction (X12 276/277) was supportedby 21.
• Three other transactions, Healthcare Services Request for Review & Response (X12 278), Enrollment in a Health Plan (X12 834), and PremiumPayments (X12 820), were supported by 18 products.
• The Healthcare Claims — Dental transaction (X12 837 D) was supported by only four of the products.
• Two of the products, totaling 150 installations, supported all nine transactions.
• 17 of the products were certified for compatibility by a third-party, while all transfers, with the exception of the Healthcare Claims — Dental transfer, were third-party tested for 60 to 68 percent of the products surveyed.
• 23 of the products will require upgrades to achieve compatibility; 19 of these will be free. All vendors plan to offer their clients assistance in implementing the upgrades.