Maria, I did not mean to imply that X12 had changed its position... which, as I understand it, is that the "vision discussion" in X12 must remain on hold until a more "broad representation from the industry" comes forward to 1. confirm the nature of the claim processes and data flows I and 3 payors have been describing for 18 months, and 2. confirm exactly which unsupported data elements are considered critical (mostly for claims) to most payors... particularly to the largest payor with the most "granular" needs.
Hopefully, AOA's meeting on 5-10 will shed enough additional light on this, that its outcome can represent the "broad representation" that X12 (and ASIG) is looking for. THAT, however, has turned out to a much bigger challenge than the technical coding issues. We are still very receptive to any help that the DSMO organizations can visualize... but getting payors to state their their data element requirements for claim adjudication has been the "brick wall" issue for us. Short of a subpoena, I am starting to run out of creative "outreach" ideas. As you know, 3 or four payors have extraordinarily cooperative and participated in the discussion all along... so we know a LOT about what those guys need. The payor with the greatest unmet needs, however, considers them to be proprietary and confidential and does not wish to discuss them with me or anyone. How to get silent payors to clearly state their needs is where we seem to be stuck... and time is running out for doctor software vendors and for the participating payors. I was hoping to have a substantive discussion at the June X12 meeting regarding the 837 proposal that was floated briefly in Seattle. Hopefully, the results of the AOA's 5-10 meeting will provide X12 that we have done enough of our 'homework" to at least move forward on this. I'm pretty sure that we all want to avoid a claim attachment if possible... because this data is required for 80% of the optometrist's claims. So I am "assuming" that X12 will be the best context in which to develop at least the initial solution. If payors still require something that cannot be represented in the 837 (with an adequate codeset) then it would be reasonable to revisit the "attachment" idea. Does this make sense to you, Maria? -Chris At 12:11 AM 4/16/02 -0500, [EMAIL PROTECTED] wrote: >Chris > >Your comment below assumes that the solution is an X12 solution, I was not >aware that X12 had made such a decision. I thought the purpose (as >articulated by everyone from the vision industry that attended the HL7 >meeting in Jan) of the meeting sponsored by the AOA was to try and get your >collective arms around what the issues were, including what CMS's >interpretation might be, and then try and determine what the correct >technical solution was. As you will recall, HL7 and later X12 and NCPDP >all agreed to help the industry in hashing this out. > >The feedback that I've gotten from X12N TG2 WG2 (claims) is that we aren't >there yet and that there haven't been decisions made regarding the use of >the claim for any part of the technical solution yet. I could have fallen >behind on the dialouge however. Has WG2 made the decision to use the FRM? >I would have thought this would have been a decision made in collaboration >with HL7 as putting "lists/ forms" of informaiton (what the FRM currently >does for DME CMN's) is essentially the same thing as providing the >attachment forms we develop in HL7. WG2 members will recall that the FRM >is slated for removal from the 837 once a migration of the DME information >is made to HL7 as an attachment (currently under development). The FRM was >only included for this purpose in the first place because there was no >attachment standard yet. > > >Maria > > > > > > > > >"Christopher J. Feahr, OD" <[EMAIL PROTECTED]> on 04/15/2002 07:38:22 PM >To: "Koller, Greg" <[EMAIL PROTECTED]>, [EMAIL PROTECTED], George > Kaye <[EMAIL PROTECTED]>, [EMAIL PROTECTED] >cc: >Subject: RE: Code Set effectivity compliance testing > > >Greg, >For what it's worth, I believe CMS representatives have been invited to an >American Optometric Association sponsored meeting next month for members of >the vision industry. It will be interesting to hear their thoughts on >this. The additional confusion we have around code sets for eyewear plans >has put our provider software community even further behind schedule. > >In fact, returning to the "version control" thread for a minute... vision >CEs may well be faced with a MUCH more serious problem than possibly having >to support both a "version A" and "version B" of a standard for >awhile. Given the fundamental nature of our codeset problems, the version >required on 10-16-03 just, flat doesn't work. If a "version B" compromise >that DOES work for payors is identified...shepherded through the DSMO... >the NPRM process... etc. etc., it still might be years before we can even >use it on a voluntary basis... because it will still be technically >different from the current standard.... maybe not different enough to break >anyone else's adjudication system, but different enough to require the >receiver to "relax" his compliance checker rules. > >Some sort of "Papal Dispensation" may be needed to permit the vision >industry to use a later (i.e., not-yet-required or not-yet-approved) >version of the standard, as soon as it can be considered "closed for >comment" within X12. > >-Chris > >At 08:50 PM 4/14/02 -0500, Koller, Greg wrote: > >Chris, > > > >I concur. > > > >Every time I meet with a provider they start looking like deer in the > >headlights when I try to explain this. Part of the problem is the number >of > >vendors out there consistently telling them they will be compliant. I am > >not so sure the vendors are far off with their understanding. Yet, we > >continue to see major payers that are not yet at the point of introducing > >anything. The all or nothing concept with HIPAA is going to be >devastating > >to these providers, because they do not understand the additional data >they > >will be required to collect. > > > >As a clearinghouse, we have advocated strongly for the staged approach. > >Start publishing elements that are required and setting timeframes for >them. > >I think the biggest step for most entities will be moving from a flat NSF >or > >HCFA to a Looping ANSI, 4010 but not compliant. Payers should be doing >that > >- NOW! Next, start asking for and setting timeframes for the required > >elements, specifically those that are readily available or relational to > >current data. Lastly, set timeframes for non-relational and > >optional/situational data that the payer will require. That basically > >brings us to compliance. This will not only start getting reasonable >efforts > >made towards compliance, but it will educate the providers on what is at > >hand as we go along. I think the perfect opportunity to make such a method > >viable would be to have CMS take the lead in such a program. > > > >Just a theory. > > > >Greg Koller > >Manager of Operations and Business Development > >United Wisconsin Proservices > >(414)226-5520 > >[EMAIL PROTECTED] > > > > > > > > -----Original Message----- > >From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]] > >Sent: Saturday, April 13, 2002 1:07 PM > >To: [EMAIL PROTECTED]; George Kaye; [EMAIL PROTECTED] > >Subject: Re: Code Set effectivity compliance testing > > > >Kepa, > >Has there been any discussion of the mechanism (and where its funding >might > >come from) by which providers' software vendors can be EDUCATED regarding > >this critically important issue? I have not met a single Office >Management > >System vendor yet who understands that even if the X12 EDI messages are >not > >going to be flying right out of the doctor's software, the required data > >elements for populating an 837 DO have to be in there and WILL have to be > >packaged up and handed off at some point to a "translator engine/entity" > >for conversion to the standard. I doubt that more than 5% of the OMS > >vendor community gets it that NONE of the old claim standards map reliably > >and consistently to the new HIPAA standards, and that sending NSF and >"1500 > >print images" to a clearinghouse is NOT going to be much help to the > >doctor. Unless CHs and payors are prepared to massively "relax" these > >standards for awhile, we will be looking at a 90% reject rate for claims > >from small providers. This global misunderstanding (they don't even know > >that they don't know) may explain why almost no software vendors or >doctors > >are coming to X12 meetings or asking questions about this... only a year > >before they are supposed to be in "testing mode". > > > >(And if you think the OMS community is out of the loop on TCS standards, > >try asking a few doctors what they know about this! I'm doing a primarily > >TCS-related HIPAA presentation to 50 or 60 eye doctors in N. Calif. next > >week and they are pretty excited about hearing this. To date, all doctors > >have heard/read about HIPAA is the Privacy Rule. They just assume that > >their OMS vendors are wiring the TCS stuff into their next system >upgrade.) > > > >Regards, > >Chris > > > >At 09:56 PM 4/8/02 -0600, Kepa Zubeldia wrote: > > >George, > > > > > >That is a very interesting point. Is your assumption that the > >clearinghouse > > >creates the transactions and has control of the code sets? The fact >that > >the > > >clearinghouse has demonstrated the "capability" to use a certain code >set > > >does not necessarily mean that each one of the providers clients of that > > >clearinghouse is using that same code set. I wish life was that easy. > > > > > >One of the typical "HIPAA Myths" is that the clearinghouses can >magically > > >make the providers compliant. That is not the case. Let's make sure >that > > >all the players understand what is their own responsibility. If the > > >expectations from providers are that their vendor or clearinghouse will > >take > > >care of HIPAA much like they took care of Y2K, we will run into big > >problems > > >when they wake up to the reality. > > > > > >Kepa > > > > > > > > > > > > > > >On Monday 08 April 2002 02:58 pm, George Kaye wrote: > > > > If a payer performs compliance testing with a clearinghouse for code >set > > > > effectivity for a professional claim (for example), has anyone >thought > > > > through the process of what that testing should consist of, so that >the > > > > payer can assume that those code sets will continue to be compliant >from > > > > that clearinghouse on an ongoing basis regardless of: the type of > > > > professional claim (office visit, ambulance, physical therapy etc.), >or > > > > when the code is impacted by new code set releases by the DSMO's? > > > > > >To be removed from this list, go to: > > >http://snip.wedi.org/unsubscribe.cfm?list=business > > >and enter your email address. > > > > > >The WEDI SNIP listserv to which you are subscribed is not moderated. >The > > >discussions on this listserv therefore represent the views of the > > >individual participants, and do not necessarily represent the views of >the > > >WEDI Board of Directors nor WEDI SNIP. If you wish to receive an >official > > >opinion, post your question to the WEDI SNIP Issues Database at > > >http://snip.wedi.org/tracking/. > > >Posting of advertisements or other commercial use of this listserv is > > >specifically prohibited. > > > >Christopher J. Feahr, OD > >http://visiondatastandard.org > >[EMAIL PROTECTED] > >Cell/Pager: 707-529-2268 > > > > > >To be removed from this list, go to: > >http://snip.wedi.org/unsubscribe.cfm?list=business > >and enter your email address. > > > >The WEDI SNIP listserv to which you are subscribed is not moderated. The > >discussions on this listserv therefore represent the views of the >individual > >participants, and do not necessarily represent the views of the WEDI Board > >of Directors nor WEDI SNIP. If you wish to receive an official opinion, > >post your question to the WEDI SNIP Issues Database at > >http://snip.wedi.org/tracking/. > >Posting of advertisements or other commercial use of this listserv is > >specifically prohibited. > >Christopher J. Feahr, OD >http://visiondatastandard.org >[EMAIL PROTECTED] >Cell/Pager: 707-529-2268 > > >To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?list=business >and enter your email address. > >The WEDI SNIP listserv to which you are subscribed is not moderated. The >discussions on this listserv therefore represent the views of the >individual participants, and do not necessarily represent the views of the >WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official >opinion, post your question to the WEDI SNIP Issues Database at >http://snip.wedi.org/tracking/. >Posting of advertisements or other commercial use of this listserv is >specifically prohibited. > > > > >---------------------------------------------------------------- >The information transmitted is intended only for the person or entity to >which it is addressed and may contain confidential and/or privileged >material. Any review, retransmission, dissemination or other use of, or >taking of any action in reliance upon, this information by persons or >entities other than the intended recipient is prohibited. If you received >this in error, please contact the sender and delete the material from any >computer. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address. The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
