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Getting a Headstart on HIPAA

Mercator's InsideHIPAA facilitates translation of HIPAA-compliant claims transactions to standard Mutual of Omaha is accustomed to accepting.

Three years prior to the HIPAA compliance deadline—originally slated for Oct. 16, 2002—Mutual of Omaha wanted to assess just how much work and time compliance would require. Management decided in October 1999 that a gap analysis was in order, relates Terry Christensen, manager, information services administration simplification and EDI (electronic data interchange).

With the help of six consultants from Deloitte & Touche (New York), a team of four members of Mutual of Omaha's ($16 billion in assets under management) IT team commenced the two-and-a-half month process. After the systems analysis, in January 2000 it was determined that to ensure compliance, Mutual of Omaha had to make sure that its legacy systems could accept ANSI (American National Standards Institute) transactions for processing. Additionally, for certain types of transactions, response information had to be retrieved and sent out to various parties.

At the time of the analysis, the carrier was accepting claims transactions in the NSF (National Standards Format) professional claims standard, and the UB92, institutional claims standard. After approaching Wilton, CT-based Mercator in February 2000, Mutual of Omaha decided that the best plan of attack would be to use the maps contained in Mercator's InsideHIPAA tool to translate inbound claims transactions from the HIPAA-required ANSI X12 EDI standard to the NSF and UB92 transactions that it was accustomed to accepting.

The insurer determined that this method made the most sense financially. "The most cost-effective way to implement the claims transaction standard was by converting incoming HIPAA-compliant standards," says Christensen. "We evaluated the view of remediating the adjudication system to accept HIPAA-compliant transactions, and decided to pursue the conversion instead." To make sure the plan worked, the carrier decided to run a pilot.

The pilot began in June 2000 with the help of Mercator consultants. According to Christensen, the establishment of a "landing zone," or data store, was developed for everything going in and coming out of the company. Before incoming transactions are sent to the legacy system, they are sent to this management facility or landing zone. The database-named eTraM (electronic transaction management facility)—was built in an IBM (Armonk, NY) DB2 environment running on IBM's OS/390 operatingsystem.

From EDI to NSF

During the pilot, Mercator maps able to translate HIPAA-compliant transactions were installed. Before a transaction is moved from the database to Mutual of Omaha's adjudication system, a Mercator map translates it from the HIPAA-compliant format into the NSF format.

After the claims transaction pilot's completion in July 2000, other transactions had to be tackled, such as eligibility, which involves both an initial request and a response. Additionally, the carrier needed to implement the pre-certification, electronic remittance advice, claims status request and response transaction maps.

When a transaction that requires a response is received by eTraM, its response is built in the database. During this time processes that form a response are executed, according to Christensen. Once the proper information is gathered, a blend of DB2-stored procedures, Cobol programs and elements of Mercator's InsideHIPAA form the response in the HIPAA-compliant format.

Although modifications to the HIPAA privacy rule allowing for a one-year extension for amending business associate contracts were released last August, as of October 13 Mutual of Omaha was ready to receive transactions and bring on data partners, reports Christensen. "Mutual of Omaha deemed it beneficial to be ahead of the curve and bring on trading partners as they were ready," says Christensen. The company "was one of the first payors in the country to provide a HIPAA-compliant solution by Oct. 16, 2002."

----------------------------------- Case Study Closeup

COMPANY: Mutual of Omaha, Omaha, NE, $16 billion in assets.

LINES OF BUSINESS: Life, annuities, health, property & casualty and long-term care.

VENDOR/TECHNOLOGY: Mercator's (Wilton, CT) InsideHIPAA.

CHALLENGE: Translate incoming and outgoing transactions for HIPAA compliance.

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