This WEDI SNIP Business Issues Subworkgroup conference call
was conducted from 3:30 - 5:00 PM Eastern time on Tuesday, April 16, 2002.
Cochairs Marcallee Jackson, Zon Owen, & Lin Quinkert presided.
~~~
(1) Miscellaneous Discussions (Zon
O)
Stanley Nachimson of HHS noted that the electronic
submission option is now available for those filing ASCA
exceptions.
Stanley also noted that it may be OK to accept all good claims
in a transmission that includes some bad claims.
(2) Administrative Issues (Lin Q)
SNIP is soliciting nominees or volunteers for the two open
Transactions Workgroup cochair positions. These must be WEDI
members.
The latest ASPIRE and COB white papers have been approved by
the Transactions WG.
We have decided to merge the Code Set Resolution white paper
into the Data and Code Set Compliance white paper as part of a future revision
of that paper.
(3) White Paper (WP) Status Reports (Zon O)
Data & Code Set Compliance WP: Zon noted that Liza
Moran is on vacation at this point, but expects to have a revised copy of this
WP ready for review during our 04/30 conference call.
Implementation Guide Selection WP: Zon noted that this
group is still gathering and analyzing the responses to its industry
survey.
Routing WP: Zon noted that this effort is still in
the discussion phases. Their goal is to create an implementable
specification, but they might also generate a short white paper that would serve
as an introduction to it.
Contingency Planning (Kepa Zubeldia & Zon O):
Zon noted that this group was formed around 11/2001 and had a
conference call in early December. Since then this subject has been
discussed at length at the Baltimore WEDI SNIP meeting and at the HIPAA Summit
II West conference. We now need to figure out what our next step(s) will
be within SNIP.
Kepa noted that some 837 data isn't available in the NSF or
other formats. These fields will frequently be filled with defaults (0's,
9's, etc.), and it could be quite advantageous to standardize these
defaults. Zon noted that this could be done by types of data, and wouldn't
have to be specified for each occurrence in each IG.
X12N/TG8 has issued an opinion that concludes that the words
"should" and "should not" are used in an advisory sense within the IGs, and are
not compelling, while the words "must" and "must not" are compelling. Kepa
thinks that this has made interpretation of the IGs much more difficult, and
that some entities are interpreting this in their own favor. Kepa thinks
that we may need a more relaxed version of the IGs to accommodate this, and that
our SNIP Contingency Planning SIG could make recommendations on this. This
"Cliff Notes" development effort would need to be done ASAP using highly
knowledgeable resources, and might need some special funding.
Debbi Meisner noted that translators often need
such defaults, but that they don't usually deal with the adjudication
data. She would discourage this. Kepa noted that he would prefer to
relax some of the rules. Debbi noted that the creation of separate pipes
(for strict and relaxed data) is an unpopular alternative for this. Debbi
noted that less than 1% of their clients are using the HIPAA 837, while the
others still need a service code and/or a student status code, etc., to do
their business.
Zon asked for a clarification of what is in scope
and what is out of scope for the Contingency Planning SIG, and noted that there
is now increasing concern about having the addenda and NDC code rules in final
form in time for a 10/2003 implementation date. Kepa suggested that
Debbi's draft WP could become a separate WP on defaults.
Marcallee noted that we could also indicate what
data could be used in certain circumstances. E.g., if certain data isn't
available, the billing provider data could be used. The point would be to
make this usage consistent.
Debbi M suggested that the phasing scheme described
in her draft WP would help. The industry could start out enforcing general
format constraints, then enforce more detailed data content constraints,
etc. She has seen some supplemental guides, but they are usually applying
proprietary edits.
Chris F asked if this whole process might take too
long to be useful. Kepa thinks that it can be done in about two
weeks. He suggest that we start with Debbi's paper, explaining the
problems with defaults and then providing them where they are justified.
The Cliff Notes would need about two weeks of highly concentrated effort, or a
much longer time following the normal processes. Kepa noted that they
accomplished a great deal in less than three days in a somewhat similar
situation several years ago. We might be able to schedule this just after
the May WEDI meeting in Denver, or just before or after the June X12 meeting in
Minneapolis. It would also be important to have a Medicare representative
involved, and Stanley N thinks that he can get someone for that.
Volunteers included the following: Mimi Hart,
Marcallee Jackson, Debbi Meisner, Carol Thompson, & Kepa Zubeldia.
Kepa is also aware of a number of others who are interested.
(4) Issues Data Base (IDB)
(Marcallee)
Item #104: This item related to corrected
data.
Item #126: Greg G & Claudia F noted
that they need a more general answer for this. For example, how does the
X12 275 fit into this scheme? Marcallee asked if it was possible to pend
the X12 278. Greg noted that the associated X12 WG envisions pending the
278 and then generating a 275. Stanley Nachimson of HHS noted that this
would be OK if the 278 IG allows for requesting an attachment. Kathleen C
asked if a 277/275 combination would be used in this situation.
Item #128: The CPT code set must be purchased
from the AMA. The HCPCS code set can be downloaded from the CMS web
site. The ICD-9 code set can be downloaded from the CDC/NCHS web
site.
Item #140: Are PDFs and other hardcopy
equivalents OK if used in addition to the 835? Zon suggested that they
might be, but Stanley Nachimson disagreed, noting that HHS considers any
computer-to-computer exchange to be an electronic transaction that must use the
standard. Zon suggested that the 835 is an accounting-oriented transaction
that should map to the providers accounting systems, but that it does not map
directly to a health plans benefits. There was much additional discussion
of this issue.
(5) Other Items
None.
The next Business Issues Conference Call will
be on Tuesday, April 30, 2002, at 3:30 Eastern
time.
~~~
These minutes were prepared by Shelley Maiden and Zon
Owen.
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