Axway & Edifecs to provide integrated solutions for new HIPAA regulations

Axway, the leading global provider of multi-enterprise solutions and infrastructure has recently formed a partnership with Edifecs to provide integrated migration solutions for the Health Insurance Portability and Accountability Act (HIPAA) modifications recently disclosed by the Centers for Medicare and Medicaid Services (CMS). Additionally, these solutions will support companies with Workgroup for Electronic Data Interchange’s (WEDI) Strategic National Implementation Process (SNIP) Type 1-7 testing, and provide validation and error reporting capabilities to trading partners.

“Healthcare organizations should put HIPAA 5010 and ICD-10 migration initiatives in place soon, as delays may be costly and create process inefficiencies,” said Todd Feinroth, senior vice president, sales & alliances, Edifecs adding, “The Axway/Edifecs joint solutions will deliver compliance tools, 5010 transaction processing capabilities, and services that are unmatched in the industry to assist with various global and internal company initiatives.”

To facilitate U.S. transition to an electronic healthcare environment, one of the two final rules in the new HIPAA mandates is the updated X12 standard Version 5010 which includes new guidelines for claims, eligibility inquiries, referral authorization, remittance advice and more. It adopts an updated version of the National Council for Prescription Drug Programs (NCPDP) standard, and a standard for Medicaid pharmacy subrogation transactions.

“These new HIPAA regulations and changes in the industry are causing pharmacy benefit managers, hospitals, doctors, and insurance companies to implement new policies in order to facilitate the interoperability of stakeholder systems and drive efficiencies,” said Sia Zadeh, director, business development, Axway. “Our objective with Edifecs is to develop solutions to make achieving data quality and compliance easier for healthcare companies. This will help them be more competitive by driving automated transaction processing throughout their organizations.”

1 March 17, 2009 was the first of two effective dates for the latest modifications to the HIPAA Electronic Transaction Standards final rule. The final rule adopts new versions (ASC X12 Version 5010) of the electronic transactions standards and (ICD-10-CM and ICD-10-PCS) Medical Data Code Set Standards of HIPAA. The final rule also adopts two standards for billing retail pharmacy supplies and professional services, and clarifies who the “senders” and “receivers” are in the descriptions of certain healthcare transactions. Mandatory compliance of these standards is January 1, 2012. Finally, a transaction standard for Medicaid pharmacy subrogation will go into effect January 1, 2010, with mandatory compliance January 1, 2013.