Since so many people don't have the history here, I'd like to add a few
comments to Gary's message below:
1) The recommendations that were made by the DSMO were strictly in
response to public comments received during the NPRM comment period, they
were not just DSMO discussions as part of our normal course of business.
This is important to understand because we (DSMO) made these
recommendations to HHS based on what the public was saying relative to
these issues. In the case of the provider taxonomy code there were a
number of comments stating that this would be quite burdensome for the
institutional provider community and that it should be removed. There were
also a few comments from one sector of the payer community expressing a
need for it.
2) Gary asks for specific situations where these items are needed within
the implementation guides. Conversely, if these items remain in the
addenda (as they are currently published) and as such will have a negative
impact on your business, you need to submit that comment as well. The
intent here is to get the full picture of how these particular data
content issues will affect the industry, so you must also speak up if
leaving these items "as is" will be problematic. This will help those
reviewing the comments get a better idea of how the changes will affect all
stakeholders.
Maria
Maria Ward
PricewaterhouseCoopers, LLP
Healthcare Consulting Practice
312.298.2586
"David A.
Feinberg, C.D.P." To: <[EMAIL PROTECTED]>,
<[EMAIL PROTECTED]>, <[EMAIL PROTECTED]>
<dafeinberg@attbi. cc:
com> Subject: Fw: Addenda Public Review
Announcement
08/28/2002 09:07
AM
Please respond to
transactions
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
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