HIPAA.ORG EDI Practice Management System Directory

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Brought to you by:
AFEHCT
American Academy of Dermatology Association
American Academy of Family Physicians
American Academy of Pediatrics
American College of Foot and Ankle Surgeons
American College of Physician Executives
American College of Physicians - American Society of Internal Medicine
American College of Obstetricians and Gynecologists
American Academy of Neurology
American Osteopathic Association
American Society of Anesthesiologists
American Urological Association, Inc.
Medical Group Management Association
NCHICA
North American Spine Society
WEDI

Instructions on the use and interpretation of information contained in the Directory:

General: Medical practices and other providers are required by HIPAA to utilize new standard electronic formats for exchanging administrative information (claims forms for example) with health plans and insurance companies after October 15, 2003. This is also the date after which Medicare will only accept claims submitted electronically; these, too, must be in HIPAA standard formats.

Most providers will depend on their practice management system (PMS) software vendors, or billing and accounting software vendors, to assist the practice transition from electronic submission of data in non-HIPAA formats to submission in HIPAA-standard formats. There is no such thing as "HIPAA compliant" software. The responsibility to be compliant rests with the practice. However, the software can be "HIPAA ready" or not.

This Directory was conceived and designed to make it easy for a medical practice to determine when and how a practice management system software product will be ready to submit and receive HIPAA standard transactions, as well as to provide information about whom to contact at the company for further details on their HIPAA implementation strategy.

Suggested steps in using the Directory:

  1. The first step in using the Directory is to locate a software company in the alphabetical list on the Directory home page. This could be the PMS vendor that your practice already uses, or one that you would like to consider using in the future. All of the information in the Directory is provided voluntarily by the companies themselves; note the appropriate disclaimers on each page of the Directory. Also note the field "last updated on" and the date. This will indicate how current the information in the Directory is for the company.
  2. After you have clicked on the company name, you will see the company information displayed in a table labeled "Vendor Information." The first section displays the company's demographic information, including the name and email address of the contact person to whom you can communicate questions about HIPAA compliance. The "Comments" field may supply you with additional information relevant to HIPAA readiness of that company or its products.
  3. The next section below the Vendor Information table contains product and transactions-specific information.
    1. Locate the product you use currently, or wish to use.
    2. Note the version and release date, and whether or not the software will support HIPAA transactions.
    3. An "N" in the "HIPAA Transactions Support" field means that the product does not support any of the electronic transactions in HIPAA format, either directly nor through a clearinghouse. This product would not assist your practice to comply with the HIPAA Transactions and Code Sets Rule. A "Y" in the same field indicates that the software does, or will, support at least one HIPAA transaction.
    4. For each transaction that a product or version supports, there is a table indicating what clearinghouse(s) will accept the transaction for transmission to the payers, and whether or not a clearinghouse is required for that transaction to be translated to the HIPAA standard format.
    5. Finally, there is an entry for each transaction indicating what third party entity has tested and/or certified that transaction.

    i. Testing means the HIPAA transactions have been verified by a commercial testing tool or an outside trading partner.
    ii. Certification means a third party has issued a statement that the transactions are HIPAA compliant and indicates what an entity's specific HIPAA EDI compliance capabilities are.