Change Request Detail
No.
1042
Date
7/29/2006
Submitter
Type of Request
Payment of a Health Care Claim
Status
DSMO Process Completed
Business Reason
X12 Insurance Subcommittee (N), the Health Care Task Group (TG2), and the Claim Payment Work Group (WG3) are submitting the following Technical Report Type 3 (TR3) as a version upgrade/replacement for the 835 HIPAA transaction, which is currently adopted and implemented using version 004010A1. 

The new version is X12 5010 Implementation Guide (TR3) designated 005010X221 835 Health Care Claim Payment / Advice.
Suggestion
Recommend to NCVHS that the 005010 version of the X12 835 transaction together with its X12 005010 TR3 (Implementation Guide) 005010X221 for the Health Care Claim Payment/Advice standard be named to replace the current HIPAA mandated transaction version 4010 and its Implementation Guide designated as 004010X091A1.

DSMO Category
I
Recommendation
Approve. Recommend to NCVHS that the 005010 version of the X12 835 transaction together with its X12 005010 TR3 (Implementation Guide) 005010X221 for the Health Care Claim Payment/Advice standard be named to replace the current HIPAA mandated transaction version 4010 and its Implementation Guide designated as 004010X091A1. The DSMO is aware of ongoing industry efforts (WEDI 835SIG) to address and resolve issues encountered in the current 004010A1 implementation guide, and therefore, believe that quick adoption of the 005010 TR3 is needed.  The DSMO also encourages NCVHS to have the 835 adoption occur simultaneously with the 837 Health Care Claims version upgrades to facilitate industry end-to-end testing, as well as avoiding duplication of testing processes and resources if conducted in a serial fashion.The DSMO acknowledges that the maintenance of administrative transaction standards is an evolving process and looks forward to continuing to work on improving the standards and the business processes they support.
Appeal Recommendation