CareOregon is a non-profit health plan serving Medicaid and Medicare recipients in Oregon. CareOregon’s goal is to help assure that the people of Oregon, cialis usa online regardless of income or social circumstance, cialis sales cialis have access to high-quality health care from a stable network of providers.

CareOregon purchased the Stott Creations’ EDI Archiving Tool which allows them to marry the HIPAA X12 834 (membership, benefit enrollment and maintenance) transaction data to the HIPAA X12, 820 (premium payment information to another covered entity) data. This is extremely important for CareOregon as it allows them to import the 834 into SQL and then create new 834 files to import into their core claim’s management system. They are now able to remove duplicative and unnecessary records, order the records for import, and most importantly move the data in the original file to the 834 segment location that our system expects.

Care Oregon is now able to know for certain how much money the state will be depositing into their account for the members who are on their roster. And on the cost savings side, they have reduced the weekly hours required of System Application Coordinators by almost 25%, and reduced by over 17% the per week hourly requirement of a Developer.

The overall intent of the current engagement is to bring the BizTalk Server and SQL system into compliance with HIPAA 5010 formats to run 834 and 820 transactions between CareOregon and the State of Oregon (per mandated HHS / CMS requirements).

Based on their success, other Health Plans are beginning to research the way they manage 834 transactions, and can see the potential advantages for pre-processing before importing their 834’s into the TriZetto QNXT Connect (which provides a web services based electronic exchange of HIPAA-ready standard transactions between a health plan and its trading partners).

Reference Information:

The X12 834 Transaction is the HIPAA-compliant Benefit Enrollment and Maintenance Transaction. Its purpose is to electronically transmit enrollment and dis-enrollment information.

One of the twelve specific HIPAA standard transactions is described as being when a health plan sends premium payment information to another covered entity. For this business case, HIPAA mandates that the X12 820transaction be used.