ASC X12 Insurance Subcommittee

Upward/Downward Compatibility
Education White Paper


I.      BACKGROUND

Education has been of major significance to many industries that have 
implemented or are currently implementing EDI.  After companies and 
industries have made the commitment to EDI, the pace of 
implementation becomes dependent on a level of understanding of this 
technology within the industry.  This level of comprehension is 
achieved primarily through education and experience.  In a preferred 
environment, education precedes experience. However in reality, on 
the job training is often used as a substitute for education (worst 
case scenario) or may occur prior to education.  In any instance as 
the level of understanding increases whether through education or 
experience so does the level of proficiency.  With this increased 
level of proficiency comes unique utilizations of EDI.  Formal EDI 
education coupled with experience helps to reduce the learning curve 
necessary to achieve this level of proficiency.

Formal EDI education is available through various organizations.  A 
number of courses are offered at the full trimester X12 meetings that 
occur in February, June and October.  The Data Interchange Standards 
Association (DISA) sponsors an annual exhibit and conference that 
provides education at all levels --- beginning, intermediate and 
advanced.  Some industry action groups offer extensive EDI training 
at both the business and technical level.  A major source for 
specific technical training can be obtained from EDI vendors of 
translation software.  This training is typically included in the 
contract.  This training will tend to be vendor specific.  Some local 
EDI user groups provide EDI training sessions as well.

In most cases enrollment in these sessions involves a registration 
fee.  Costs other than registration that occur as a result of 
attending these sessions includes travel and living expenses.

Additionally informal education is acquired as individuals involved 
in administering EDI at their companies "network" with their peers.  
Some industries promote this networking by getting new trading 
partners in contact with current trading partners that are similar to 
the new partner's line of business.  Networking promotes comraderie 
and valuable exchange of knowledge among EDI users regardless of 
whether there are alliances, competitors or mutually exclusive 
businesses.

II.     CHALLENGE

As an industry embarks on the incorporation of new technologies into 
their work practices the question of education begins to emerge.  It 
is a question of educating the industry in the use of the new 
technology as well as gaining the expertise in order to determine 
applicability and potential use or maximization within the industry.  
With the onset of EDI (as a technology as well as a business 
philosophy) into an industry, the same education challenge exists.  
The larger the user base in the industry the more significant the 
challenge.

As each industry begins it's journey into EDI/ Electronic Commerce 
(EC), many new issues such as variable formats, CPU-CPU 
transmissions, envelopes, functional groups and translators are 
introduced.  Initially there is little EDI expertise in the industry 
to address this need, thus creating a learning curve that must be 
addressed and overcome.

Coupled with the advent of EDI is the appearance of electronic mail, 
imaging, messaging, graphics, and many other Electronic Commerce (EC) 
technologies that must also be understood.  The ultimate goal is to 
be an EDI fluent industry through increasing the knowledge base of 
the user community relative to EDI and EC.

Industries thus far have migrated to a paperless world via EDI at a 
pace corresponding to business need.  Some industries are under 
government edicts to become paperless and electronic.  The 
procurement process within the federal government is well on the way 
in implementing EDI to achieve a paperless process.  Another sector 
of the economy that must be responsive to government time frames is 
health care.  Due to the volume of health care entities as well as 
the number of X12 transactions to be implemented, education relative 
to this new terminology, philosophy and technology becomes quite a 
feat.  In the event that legislation (federal or state) is passed the 
expediency for education becomes exacerbated.  In other instances 
major players in an industry have required their suppliers to do EDI 
to continue the business relationship.  EDI abilities have been 
incorporated in audits conducted by customers of their suppliers.  
Proficiency with EDI/ EC has become a business requirement.

EDI/ EC education must be conducted from both a business and 
technical perspective.  Receiving and sending information in an 
electronic fashion will necessitate modifications to business work 
practices.   This awareness must be conveyed to the EDI/ EC business 
implementer as well as the technical personnel involved with EDI/ EC 
implementations.  Detailed technical training is also required for 
the technical implementers.  However an awareness of high level 
technical issues must also be comprehended by affected business 
personnel.  Hence, EDI/ EC education needs to be addressed at both a 
business and technical level.

The challenge becomes taking an industry that is a novice to EDI and 
evolving it into an EDI capable industry in the shortest time frame 
allowed by either legislation or competitive forces.  Education is a 
critical part in transforming the health care industry from a paper 
based batch data transmission intensive industry to an electronic 
interactive industry.  The quest is to massively deploy standards in 
a time frame conducive to legislative and competitive requirements.

III.    SCOPE AND OBJECTIVE

The scope of this white paper is to address educational EDI issues 
relative to the migration of American business and society to the 
electronic information age.

By definition, the meaning of "to educate" is to provide with 
training for some particular purpose.  Extrapolating this definition 
relative to EC/ EDI would imply providing training for personnel 
(enterprises) utilizing EC/ EDI in their business environment or for 
personal use.  Basic education would provide the foundation and 
knowledge base relative to EC/ EDI concepts and functionalities while 
advanced education would focus upon philosophy, strategy and various 
methods of deployment.

Education becomes particularly significant when massively deploying 
these technologies in an industry in which they are relatively new.  
It becomes crucial if legislation is enacted that stipulates specific 
time frames for implementation.  Health care is an example of such an 
industry.  Standards based EDI is relatively new in health care.  A 
firm conceptualization and understanding concerning the philosophy of 
these technologies is still developing in health care.  Legislation 
regarding health care at both the federal and state level requires 
the use of electronic standardized formats.  Some legislative bills 
specifically refer to the implementation and utilization of X12 
formats.  When the pace of implementation is accelerated by 
legislation or through competitive forces, the need for more 
educational opportunities to satisfy a large user base can become a 
reality very quickly.

Another example of the pending demand for education is the growing 
awareness and the availability in accessing national information 
networks.  An example of a global network could be the Internet.  
Additionally, the telephone and cable companies in America are 
preparing for the information age.  Advertisements depicting the 
capabilities provided by the telephone and cable companies are 
becoming common place specifically enticing the consumer to link to 
the network through their company.  Users of the networks must become 
knowledgeable in telecommunications, electronic mail, imaging, video 
conferencing to name a few.  Hence a different market is emerging in 
our society -- an electronic information market, creating a need and 
desire for a new kind of knowledge.

III.    EDUCATION ALTERNATIVES

The alternatives enumerated below have been identified relative to 
EDI/ EC education requirements for mass implementations in short or 
aggressive time frames.  These are possible alternatives that 
currently exist or may need to exist to fulfill EDI/ EC educational 
requirements in cases of mass implementation.  EDI/ EC educational 
requirements are both global and specific in nature. There is the 
need to understand and conceptualize the philosophy of EDI/ EC as 
well as a need for specific technical education regarding such things 
as EDI software and the implementation of transaction sets.  Hence 
education in EDI/ EC is both business and technically oriented.  The 
key is to provide a composite that meets the needs of the clientele 
of the particular class or session. 

ALTERNATIVE I   -       STATUS QUO

This alternative implies that EDI education that currently exists 
will continue to be available, however there will be no effort to 
supplement or augment this educational effort.  This is the same 
educational effort that has enabled industries such as automobile, 
transportation, retail, grocery to implement EDI in their respective 
industries.  An area of concern with this alternative is whether it 
can support an EC/ EDI initiative that is legislatively invoked in an 
industry that would necessitate a rapid industry wide or regional 
implementation.


ALTERNATIVE II  -       STATUS QUO WITH AN ACCELERATION IN 
MULTIMEDIA     TRAINING

This alternative augments current EC/ EDI education with multi media 
capabilities and requires education vendors to formulate EDI courses 
for availability to the user base either through video, self study or 
video conferencing.  This augmentation lacks the personal, individual 
teacher - student educational setting that has been so predominant in 
our country.  The effectiveness of this type of education would be 
directly related to the degree of education and understanding that is 
required.  Individuals requiring a high level or overview 
understanding may benefit more from these courses than those 
requiring an in depth understanding.  Eventually this information 
could be accessible via commercial information utilities.


ALTERNATIVE III -       NATIONAL BOARD (INHERENT IN FEDERAL                     
                LEGISLATION)

This alternative calls for EC/ EDI education to be under the realm of 
the national boards stipulated in many of the current health care 
reform bills.  Along with the other functions stipulated within the 
legislation, this board would be responsible for the proliferation of 
EDI knowledge throughout the United States.  Responsibility for EC/ 
EDI education at this level can be particularly beneficial since the 
current executive branch of our federal government has been 
emphasizing the migration to electronic commerce and the information 
autobahn.  The education provided through this effort would be 
available to those enterprises that are affiliated with government 
contracts as well as those that are not.  It would be an organized, 
controlled and planned effort to provide a focal point for the 
migration of the American society to the electronic information age.



ALTERNATIVE IV  -       STATE BOARD RESPONSIBLE FOR EC/ EDI                     
                EDUCATION

In lieu of national health care reform, many states are adopting 
reform legislation of their own.  This alternative makes the states 
responsible for providing EC/ EDI educational opportunities to their 
EC/ EDI user base.  This education can be incorporated into 
curriculum in the schools, colleges and universities.  Eventually the 
migration of the American society to an electronic information 
seeking environment would find education relative to this migration 
common place in our educational institutions.  Just as personal 
computer courses are common place today, EC/ EDI courses will need to 
be common place in tomorrow's education curriculum.


V.      ISSUES

         Availability of EDI training courses/ sessions in a 
timely manner.

         Costs affiliated with EDI training and the learning 
curve involved.

         Need to couple EDI/ EC with business process re-
engineering and the training required for this additional 
component.

         Recognition of the need for training.

         Quality uniform and comprehensive curriculum and 
leaders.

         Evaluation of training relative to effectiveness.

         Negotiation of education within the contract with 
the translation software vendor --- on-site/ off-site 
training.

         Pre-requisite of business analysis/ needs assessment 
which may require training in itself.



VI.     RECOMMENDATION

Specific educational requirements regarding EDI/ EC can vary between 
and within industries.  The educational requirement is proportional 
to the level of EDI/ EC expertise within the industry and in 
particular with the business partners involved.  Industries that have 
a large number of EDI novices will have a greater need for 
orientation type education than those industries that are more EDI/ 
EC fluent.  EDI curriculum for novice users must include an 
explanation of the X12 protocol as well as an explanation of the 
acronyms associated with this technology.  The EDI/ EC fluent 
industries will have a need for advanced EDI/ EC concepts.  
Regardless of the level of fluency the need for education exists.

For site EDI/ EC implementations, it is imperative that an 
understanding of EDI/ EC concepts from both a business and technical 
perspective be attained before undergoing the selection process for 
EDI translation software.  This understanding is critical for 
decision making purposes.  The better the understanding and 
conceptualization the better prepared the evaluators of the software 
products will be to make a well-informed business decision.   This 
understanding/ education can then be augmented with the technically 
oriented training that is offered by most translation software 
vendors.  Some additional courses that are desperately needed include 
Management of Executive Management's Expectations and Interpersonal 
and Negotiation Skills Relative to EDI Vendors.

A prerequisite to the selection process is a corporate Needs 
Analysis/ Assessment regarding EDI/ EC in the corporation.  This 
Needs Analysis should contain an understanding of the current 
environment as well as an conceptualization of corporate goals and 
objectives for the future.  To conduct and complete this analysis/ 
assessment may necessitate education/ training in itself. Inherent in 
the analysis may be the need for re-engineering of the business 
process.  This may necessitate a educational requirement to complete 
re-engineering tasks regarding process/ work , functional and data 
flow analysis.  Hence there may be additional educational needs to 
EDI/ EC.

It is recommended that all types of training/ education be uniform 
among the sponsoring agencies and comprehensive in nature.  Education 
relative to specific transactions should be intricately tied to the 
national implementation for the transaction.  For example the WEDI 
National Implementation Guide for the ASC X12 835 (Claim Payment/ 
Advice) should be the core document for a class pertaining to the 
claim payment/ advice.  

The transfer of knowledge can occur through various mediums such as 
X12 conferences, forums and through formal classroom sessions.  
Perhaps a Speaker Bureau can be established as a focal point for 
knowledgeable, quality speakers.  It is hoped that eventually 
colleges and universities will offer courses for EDI, EC and 
telecommunications relative to national information highways.


Implementation plans for EDI related education should be inherent in 
tactical plans for the implementation of transactions or in an EDI/ 
EC strategy or initiative.  Time frames relative to EDI education may 
necessitate the development of a certain level of expertise in a 
short period of time.  This may be particularly true in instances 
where standardization is mandated or legislated.  Optimal education 
solutions should be cognizant of cost, benefit and time.  Adequate 
funding for proper education should be provided so that as personnel 
gain hands-on experience and acquire certain levels of expertise, 
initial mistakes that are typically made can be avoided.  This 
proactive move should eliminate the time, effort and cost for rework 
and resolving these initial mistakes.  Depending on the required 
implementation time frame, some initial mistakes may prove to be 
unrecoverable.  Education plays a key role in the successful 
implementation of standards and the deployment of these standards in 
an industry.



Appendix A

Example of EDI Curriculum for the Health Care Industry




IV.     EDUCATION CURRICULUM

Depicted here are the areas that would need to be addressed in "any" 
of the above education alternatives.  The intent of this curriculum 
is to convey EDI in the overall EC schema.  Training pertaining to 
specific transactions would occur os preparation for implementation.  
The curriculum listed below should be considered an initial list with 
augmentation by business needs and requirements. The courses are not 
in any specific sequence or educational track.


I. ELECTRONIC COMMERCE (EC) Basics

         Define components of Electronic Commerce
         Describe components of Electronic Commerce
         Identify goals and objectives
         Identify Benefits

II. Electronic Data Interchange (EDI) Basics - Part 1

         Define EDI
         Illustrate the EDI Process
         Differentiate between EDI and EMC
         Differentiate between UB82, UB92, NSF and EDI
         Differentiate between ANSI ASC X12 and EDIFACT

III. Electronic Data Interchange (EDI) Basics - Part 2

         Differentiate between translation and transmission
         Discuss Value Added Networks, Value Added Banks
         Identify goals and objectives
         Illustrate the "Seamless Process"
         Identify Benefits

IV. Electronic Data Interchange (EDI) Organization

         Identify Players
         Identify Organizations
         Identify Standards Process
         Identify Acronyms
IV.  Electronic Data Interchange (EDI) Structure

         Discuss the X12 Process
         Discuss the language - X12ese
         Define the structure of the X12 standard
         Discuss envelope
         Discuss contents of transaction set
         Differentiate between format and data content
         Discuss compression; transmission

V.  Direct Health Care Transactions

         Review the list of direct health care transactions
         Briefly describe each of the health care 
transactions
         Pictorially depict the flow of the direct health 
care transactions amongst the various business entities
         Differentiate between inbound and outbound 
transactions

VI.  Indirect Health Care Transactions

         Review the list of the typical general business EDI 
transactions (indirect health care transactions)
         Briefly describe each of the general business 
transactions
         Pictorially depict the flow of the indirect health 
care transactions amongst various business entities
         Differentiate between inbound and outbound 
transactions

VII. ASC X12 834 Enrollment (Business) *

         What is the ASC X12 834?
         How is it used?
         Why is it used?  
         Role of the 834 in business

VIII.  ASC X12 834 Enrollment (Technical) *

         Discuss purpose and utilization of transaction
         Discuss structure of transaction
         Review segments 
         Review data elements
         Review Example

IX.  ASC X12 835 Claim Payment/Advice (Business) *

         What is the ASC X12 835?
         How is it used?
         Why is it used?  
         What is EFT?
         Role of the 835 in business

X. ASC X12 835 Claim Payment/Advice (Technical) *

         Discuss purpose and utilization of transaction
         Discuss structure of transaction
         Review segments 
         Review data elements
         Discuss Electronic Funds Transfer (EFT)
         Review Example

XI.  ASC X12 837 Claim (Business) *

         What is the ASC X12 837?
         How is it used?
         Why is it used?  
         What is COB?
         Role of the 837 in business

XII. ASC X12 837 Claim (Technical) * 

          Discuss purpose and utilization of transaction
         Discuss structure of transaction
         Review segments 
         Review data elements
         Discuss Co-ordination of Benefits (COB)
         Review Example

XIII.  ASC X12 270/271 Claim (Business) *

         What are the ASC X12 270 and the ASC X12 271?
         How are they used?
         Why are they used?  
         Health Care Service scenario of the future
         Role of the 270/271 in business

XIV. ASC X12 270/271 Eligibility Request/Response (Technical) *

         Discuss purpose and utilization of transaction
         Discuss structure of transaction
         Review segments 
         Review data elements
         Review Example

XV.  Electronic Data Interchange Case Studies

         Discuss EDI case studies
         Define components of successful implementations
         Identify things to avoid
         Identify Costs
         Identify Benefits

XVI.  Electronic Data Interchange in Health Care

         Discuss "Players"
         Review Direct and Indirect Health Care Transactions
         Discuss anticipated requirements
         Identify Costs
         Identify Benefits

XVII.  Electronic Commerce Philosophy

         Discuss Electronic Commerce technologies
         Discuss integration of technologies
         Discuss Virtual Corporation concept
         Discuss messaging
         Discuss maximization of benefits

XVIII. Electronic Data Interchange Philosophy

         Discuss concept of Seamless Processing
         Discuss integration of EDI with Application systems
         Discuss full realization of benefits
         Discuss Proactive/Reactive postures
         Discuss utilizing EDI for competitive advantage

XIX. Electronic Data Interchange and Health Care Reform

         Discuss EDI and Health Care 
Reform/Congress/Administration
         Discuss Health Care Identification Card
         Discuss Interactive Scenarios 
         Discuss the Direct Health Care Transactions
         Discuss the Indirect Health Care Transactions

XX.  The Future

         Discuss Conversational and Interactive EDI
         Discuss CHMIS/CHIN
         Discuss the National Network; Electronic Highway  
         Discuss EDI and MTS

XXI.  EDI and BPR

         Discuss business process re-engineering
         Discuss the utilization of EDI in BPR
         Discuss the utilization of EC in BPR  

XXII.  EDIFACT - Business Overview 

         Explain EDIFACT
         Discuss the business reasons in migrating to EDIFACT
         Discuss the Alignment Plan to EDIFACT
         Provide a historical background on EDIFACT
         Describe the differences between X12 and EDIFACT
         Describe the EDIFACT protocol

XXIII.  EDIFACT - Technical Overview 

         Explain message formats
         Explain segments, data elements, composite data 
elements, etc.
         Map a business document to an X12 transaction and to 
an EDIFACT message
         Explain data maintenance procedures within EDIFACT
         Explain statusing of messages


XXIV.  Implementation 

         Discuss analyzing the corporation for business needs
         Discuss the steps involved in completing a Needs 
Assessment
         Discuss the trading/ business partner concept  
         Discuss integration of EDI into a business direction
         Discuss formulation of a strategy, policies and 
procedures
         Discuss formulation of a corporate focal point for 
EDI/ EC
Education White Paper




1

2/6/95                                  "DRAFT FOR COMMENTS"                    

Education White Paper


2/6/95                                  "DRAFT FOR COMMENTS"                    

Education White Paper




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2/6/95                                  "DRAFT FOR COMMENTS"