The Health Insurance Portability and Accountability Act (HIPAA) requires that all healthcare organizations that exchange HIPAA transaction data electronically with the Indiana Health Coverage Programs (IHCP) establish an electronic data interchange (EDI) relationship. All entities requesting to exchange data with the IHCP must be tested and approved by the IHCP before production transmission begins.
Vendors must review the X12N transaction HIPAA implementation guides and the IHCP companion guides to carefully assess the changes needed to their businesses and technical operations to meet the requirements of HIPAA. Information about accessing the national X12N transaction HIPAA implementation guides is available on the Washington Publishing Company website at wpc-edi.com under Publications.
The IHCP Companion Guides page contains the current production versions of the IHCP companion guides, as well as future system updates to the guides.
The following steps describe the testing process for EDI vendors that have not yet been approved by the IHCP.
1. Complete the Trading Partner Profile
The IHCP requires each testing entity exchanging data directly with the IHCP to complete and submit the IHCP Trading Partner Profile to initiate the testing process. The IHCP Trading Partner Profile is the tool the vendor must use to notify the IHCP about the types of transactions they will test and the method of communication they will use. When the IHCP receives the profile form, testing information is sent to the vendor. Follow the instructions received in the testing information to ensure accuracy and completeness of testing.
2. Conduct Application Development
The vendor must modify its business application systems to comply with the IHCP companion guides. The accuracy of the vendor's system must be tested to ensure that all transactions process correctly. The vendor must determine what modifications and additions its technical infrastructure needs to perform the communication functions.
3. Test Each Transaction
Connectivity testing performed with the transmissions ensures a successful connection between the sender and receiver of data. Two levels of data testing are required: compliance testing and IHCP specification validation testing.
Compliance Testing
All transactions must pass data integrity requirements, balancing and situational compliance testing. Although third-party HIPAA certification is not required, the preceding levels of compliance are required and must be tested. Compliance is accomplished when the transaction is processed without errors and the response transaction or a 999 Acknowledgement is produced.
The software used by the IHCP for compliance checking and the translation of the HIPAA transaction is Edifecs.
IHCP Specification Validation Testing
Specification validation testing ensures conformity to the IHCP companion guides. This testing ensures that the segments or records that differ based on certain healthcare services are properly created and produced in the transaction data formats. Validation testing is unique to specific relationships between entities and includes testing field lengths, output, security, load/capacity/volume and external code sets.
4. Become an IHCP-Approved Software Vendor
The testing and approval process differs slightly for software developers, billing services and clearinghouses. The processes are described in the following subsections.
Software Developers
Entities whose clients will be submitting directly to the IHCP are not required to become IHCP trading partners. When testing and approval are complete, the IHCP sends a written notification of approval to the software developer. On receipt of this approval, the software developer should submit a list of its IHCP clients and inform its clients that its software has been approved. However, providers are required to complete the procedures outlined in Trading Partner Registration Procedure to get production submission information.
Billing Services, Clearinghouses and Managed Care Entities
At the completion of testing and approval, a written production approval notification is sent to the vendor. These entities are required to submit a list of IHCP providers for the internal system setup of any outbound transactions.
Billing services, clearinghouses and managed care entities (MCEs) must submit a signed IHCP Trading Partner Agreement. The trading partner agreement is a contract between parties that have chosen to become electronic business partners. This document stipulates the general terms and conditions under which the partners agree to exchange information electronically. The signed IHCP Trading Partner Agreement must be emailed to INXIXTradingPartner@gainwelltechnologies.com or faxed to 317-488-5185.