INDUSTRY CALL TO ACTION: PUBLIC COMMENTS SOUGHT ON THE STANDARDS FOR ELECTRONIC HEALTH CARE CLAIMS ATTACHMENTS

X12 TRANSACTIONS, HL7 SPECIFICATIONS, and LOINC CODES

(CMS-0050) On November 22, 2005, The Department of Health and Human Services (HHS) published notice of a 60 day extension to the comment period for the proposed rule titled: “HIPAA Administrative Simplification: Electronic Health Care Claims Attachments.” The public comment period will now close on January 23, 2006. A final rule is expected by the end of 2006.

The industry requested the extension in order to avoid the same standards-related implementation issues as were experienced implementing the first set of HIPAA transactions. HHS accommodated the request with the expectation that the industry would assess the proposed standards for their viability and relevance to current practices. For example, are the attachment request options in each specification booklet (HL7 Additional Information Specification) an accurate reflection of the information requested by most health plans for that claim type?

The comments will be provided to the Standards Development Organizations (SDOs): X12 and HL7, so that they can make necessary revisions and corrections, and re-ballot the standards in time for a final rule in 2006.

The proposed rule, published on September 23, 2005, recommends the adoption of a set of standards that will facilitate the electronic exchange of clinical and administrative data. These exchanges, and the standardized data format and content, are intended to improve the claims attachment adjudication process when additional documentation is required of a provider, by a health plan.

The X12 and HL7 the guides, specifications and LOINC code set should be reviewed by technical experts, but equally importantly, by business subject matter experts, such as medical review specialists and claims examiners. Without both a business and technical review, covered entities may not be able to implement the standards in the most effective or affordable way.

The standards are:

The technical materials may be found at http://www.wpc-edi.com, and are available free of charge. For further information contact Lorraine Tunis Doo at 410-786-6597.