HIPAA Transactions, Code Sets and Identifiers Program – Achieving MHS Quadruple Aim and Strategic Goals

The Health Insurance Portability and Accountability Act (HIPAA) Electronic Transactions, Code Sets and Identifiers (TCSI) Program within the Information Management (IM) division of TRICARE Management Activity (TMA) provides overall program management and coordination for the implementation of HIPAA electronic standards. This includes participation in Standards Development Organizations (SDO) such as Accredited Standards Committee (ASC) X12, performing impact analysis and requirements development for mandated standards and staying fully engaged through implementation and deployment of new or updated standards. In addition, the HIPAA TCSI Program monitors the status of regulatory activities regarding adoption of new electronic standards in order to assist the MHS with early planning and preparations for compliance.

How the HIPAA TCSI Program contributes to achieving Military Health System (MHS) Quadruple Aim and Strategic Goals:

• Reducing "per Capita cost"
  Monitoring the status of HIPAA and Health IT regulatory activities allows IM to provide valuable and early input to POM activities by providing awareness of standards that will be future mandates and therefore need to be considered during budgeting activities. Good planning helps reduce costs by allowing ample time for development, testing and implementation activities.
• Assisting with Readiness
  Proper implementation of HIPAA code sets based on industry best practices will assist the readiness mission and support the war fighter by improving the ability to transport data regarding eligibility, health & immunization status in a timely and standardized way.
• Improving Population Health
  HIPAA standards such as ICD-10 and other code sets are used to track population health. HIPAA SMEs provide insight on best business practices that can be leveraged to achieve optimal implementation of the standards. Use of best business practices will lead to more useful information in electronic health records allowing providers to make informed medical decisions improving medical care and outcomes for patients.
• Providing a Positive Patient Experience
  The implementation of HIPAA Electronic standards (automating administrative transactions such as eligibility, claims, referrals, etc.,) improves and facilitates the timeliness of these transactions and allows improved information sharing with outside entities. Example: Properly implemented electronic eligibility transactions facilitate access to care.
• Advancing IT Interoperability
  Smart implementation of HIPAA standard electronic transactions, code sets and identifiers will lead to interoperability by ensuring MHS is using the same data and standards as the rest of the industry.
• Improving the EHR
  Smart implementation of HIPAA and other electronic standards will allow the MHS to meet EHR Meaningful Use objectives (HIPAA standards are expected to be included in the Stage 2 EHR Certification & Implementation specifications criteria for certified EHRs).