Fw: Addenda Public Review Announcement

[David A. Feinberg, C.D.P.]

Following is an important request from the Chair of X12N soliciting your input regarding two important issues in the HIPAA Institutional and Professional Health Care Claims Implementation Guide Addenda currently open for public comment.  Please contribute (only) via the indicated on-line conference if you are able.   ----- Original Message ----- From: [EMAIL PROTECTED] To: X12 Insurance Sent: Tuesday, August 27, 2002 9:57 PM Subject: Addenda Public Review Announcement MEMO FROM: Gary Beatty, Chair, ASC X12N DATE: August 27, 2002 SUBJECT: Public Review Announcement   As many are aware, this past weekend ASC X12N posted for public comment new draft versions of five of the Addenda to the X12N Version 4010 Implementation Guides. These changes were made as a result of the Notice of Proposed Rule Making (NPRM - 45 CFR Part 162) to adopt the Addenda for mandated use under HIPAA, and the review of the technical comments by the Designated Standards Maintenance Organizations (DSMOs). X12N announced the 30 day public review period for the changes to the Addenda in accordance with policies, procedures, and conventions for development, review, and distribution of X12N implementation guides (Implementation Guide Handbook). The following Addenda have changed:   � Health Care Claim: Professional 837 (004010X098A1) � Health Care Claim: Institutional 837 (004010X096A1) � Health Care Claim: Dental (004010X097A1) � Health Care Claim Status Request and Response (004010X093A1) � Health Care Services Review – Request for Review and Response (004010X094A1)   X12N is soliciting specific input from the health care industry relative the following changes:   1. Health Care Claim: Institutional 837 (004010X096A1) The usage of the following Segments containing provider specialty (taxonomy) were changed to Situational with a usage note of “Required when adjudication is known to be impacted by the provider taxonomy code.”:   Loop 2000A PRV Segment - Billing/Pay-To Provider Specialty Information Loop 2310A PRV Segment – Attending Physician Specialty Information Loop 2310B PRV Segment – Operating Physician Specialty Information Loop 2310C PRV Segment – Other Provider Specialty Information Loop 2310E PRV Segment – Service Facility Specialty Information Loop 2420A PRV Segment - Attending Physician Specialty Information Loop 2420B PRV Segment - Operating Physician Specialty Information Loop 2420C PRV Segment - Other Provider Specialty Information   The DSMO recommended these segments be removed from the implementation guide because if provider taxonomy codes are used, the ASC X12N Professional Implementation Guide should be used. Also without more specific situational notes it would be up to trading partner agreements to determine the usage of this data content.   Please provide specific business needs, situational usage language and examples for provider specialty (taxonomy) within this implementation guide.   Without specific business usage notes for these segments, these segments will be removed from the Addenda.     2. Health Care Claim: Professional 837 (004010X098A1) In Loop 2400, segment SV103, the qualifier for Units of Service, during the fast track DSMO process a change request was received and approved to limited the usage to only minutes for anesthesia services. This would facilitate payer to payer coordination of benefits (COB) (HIPAA requires that the transaction supports the data content necessary for COB) where the receiving payer may not have the same definition for base units (number of minutes within a unit). During the Addenda NPRM public comment period the DHHS received a comment and the DSMO agreed to not limit the usage note on qualifier MJ - Minutes, “Required for Anesthesia claims.”, since there is the need to bill for these services by the quantity of base units as well as minutes.   Please provide specific business needs, situational usage language and examples where both “Units” and “Minutes” are required for billing anesthesia services.   Without specific business usage for the minutes only usage note, the situational note will be removed allowing for both “Units” and “Minutes”.   The authors will review and discuss any and all comments following the public review period.  Official work group responses will be sent to the individual commenter who submitted the comment and will be posted to the on-line conference. All work group responses will be posted at least 15 days prior to the corresponding Informational Forum. This is the only public review period.  For a complete understanding of changes being made to the guide, reviewers should monitor the online conference during the public review period and review all author responses prior to the Informational Forum to be held at the upcoming X12 trimester meeting in October.  Watch for the announcement of the corresponding Informational Forum. The Information Forum is the final opportunity to comment on  modifications based on the public review period comments.   The draft addenda are available for download at: http://www.wpc-edi.com/hipaa/hipaaaddenda.asp   Comments on the draft instructions can be submitted via the on-line conference at: http://www.wpc-edi.com/conferences/healthcare.html   X12N Insurance Subcommittee Gary Beatty - Chair   ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=Business and enter your email address. 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