Change Request Detail
No.
1044
Date
7/29/2006
Submitter
Type of Request
Professional Claim (HCFA 1500)
Status
DSMO Process Completed
Business Reason
X12 Insurance Subcommitte (N), the Health Care Task Group (TG2) and the Health Care Claim and Encounter Work Group (WG2) are submitting the following Technical Report Type 3 as a version upgrade / replacement for the 837 HIPAA transaction, which is currently adopted and implemented using version 004010A1.

The new X12 version is 005010 with Implementation Guide (TR3) designated 005010X222 837 Health Care Claim: Professional.
Suggestion
Recommend to NCVHS that the 005010 version of the X12 837 transaction together with the x12 005010 TR3 (Implementation Guide) 005010X222 for Health Care Claims: Professional Claims be named to replace the current HIPAA mandated transaction version 004010 and its Implementation Guides designated as 004010X098A1 .
DSMO Category
I
Recommendation
Approve.  Recommend to NCVHS that the 005010 version of the X12 837 transaction together with the x12 005010 TR3 (Implementation Guide) 005010X222 for Health Care Claims: Professional Claims be named to replace the current HIPAA mandated transaction version 004010 and its Implementation Guides designated as 004010X098A1. The DSMO appreciates the added clarity in the 5010 TR3 that will close loopholes and decrease ambiguity of various issues.  Examples identified include, definition of a billing provider, NPI, and COB.  The DSMO also recognizes that the changes will impact some of the industry’s current business practices as they adopt the modified standard.  In addition, the DSMO encourages quick adoption of the TR3, which could occur if the streamlined process, as identified by the standards development organizations and WEDI, for modifications to standards is adopted and followed.
The DSMO does acknowledge the benefit of the instruction provided in the TR3 on NPI, but the DSMO also recognizes concerns that the description of NPI implementation may pose difficulties for current non-HIPAA transaction reporting needs, including public health.
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