Group Minutes X12N Insurance June 4-8, 2017 San Antonio, TX

Transcription

1 Group Minutes X12N Insurance June 4-8, 2017 San Antonio, TX ASC X12N/ Group Leadership Chair Name Company Term End Date Phone Stacey Barber DXC February 2019 Merri-Lee Stine Aetna February 2019 Secretary Name Company Term End Date Phone Gail Kocher BCBSA Penny Probst Highmark Inc Quorum Requirement Statement This group enforces quorum requirements for group voting items. X This group does not enforce quorum requirements for group voting items. Scheduled Meetings Type of Meeting Date Location/Call in Contact Agenda Current Meeting 06/04/2017 Seattle, WA Stacey Task Group and Liaison Updates - 06/08/2017 Barber Vote on items created during this meeting Regulatory Update Next Standing 09/24/2017 Pittsburgh, PA Stacey Task Group and Liaison Updates Meeting - 09/28/2017 Barber Vote on items created during this meeting Regulatory Update Interim Meeting N/A Management Every Conference Call Stacey Standing Discussion Items Meeting other Friday Barber Liaison Reports Revised 01/2016 Page 1 of 3

2 Chair Election none Candidate(s) Nomination Vote ASC X12N/ Discussion Results Voting Items Type Issue Description Project PACDR guides moving from version 5010 to 7030 Proposals Motion Approve moving the project proposals from 5010 to 7030 Vote Motion Made by 2 nd By Approve Disapprove Abstain Laurie Burckhardt LuAnn Hetherington All 0 0 Discussion These are the 837P, 837I and 837D Post Adjudication Claims Data Reporting guides Voting Items Type Issue Description PRB Rep The primary representative stepped down at the January meeting. A representative is needed to fulfill the term, which ends January Motion Laurie Burckhardt was nominated and the motion was to approve by unanimous consent Vote Motion Made by 2 nd By Approve Disapprove Abstain Stacey Barber LuAnn Hetherington Discussion Voting Items Type Issue Description Project The 274 guides (X206 and X207) will be moved from 6020 to 7030 Proposal Motion move the guides forward to 7030 Vote Motion Made by 2 nd By Approve Disapprove Abstain Doreen Espinoza LuAnn Hetherington All 0 0 Discussion Voting Items Type Issue Description WG Purpose and Scope The TGB/WG2 (Billing Encounter and Claim Attachment Information WG) purpose and scope was modified due to the creation of WG5 (Claim Status and Claim Acknowledgment WG) Motion approve the Purpose and Scope for TGB/WG2 Vote Motion Made by 2 nd By Approve Disapprove Abstain Gloria Davis Merri-Lee Stine All 0 0 Revised 01/2016 Page 2 of 3

3 Discussion ASC X12N/ Voting Items Type Issue Description WG Purpose and Scope The WG5 (Claim Status and Claim Acknowledgment WG) Purpose and Scope was created Motion approve the Purpose and Scope for TGB/WG5 Vote Motion Made by 2 nd By Approve Disapprove Abstain Doreen Espinoza LuAnn Hetherington All 0 0 Discussion Key Discussion Item Discussion Task Group and Liaison Report In Decisions See below. This is posted on the X12N imeetcentral workspace as well. Discussion Volunteerism Decisions We need more volunteers It is important that everyone is engaged and takes part in the process Discussion Certificates of Appreciation Decisions Awarded to Jerry Sobotka Discussion Announcements Decisions X12N Management voted to realign the PACDR SAC into TGB as WG22. Laurie Burckhardt will continue to convene until co-chair elections are held. The 7030 Public Review Schedule will resume September 1 with a 90 day review period for the 278 and 270/271 transactions. An announcement will be distributed in the near future The next meeting will be in September in Pittsburgh, PA Discussion Task Group and Liaison Report Out Decisions See below. This is posted on the X12N Central Desktop workspace as well. Informational Forum or Joint Meeting Notes: none Topic Date/Time Notes Revised 01/2016 Page 3 of 3

4 REPORT IN V 04/17 ORGANIZATION REPRESENTATIVE(S) TERM END DATE ELECTIONS Technical Assessment Subcommittee X12J (TAS) Procedures Review Board (PRB) Task Group A Program Management TGA WG and Liaison Report-Ins Task Group B Business TGB WG and Liaison Report-Ins Task Group C Technical TGC WG and Liaison Report-Ins LuAnn Hetherington Becky Kimmick Open Position (Representative) Tim Pearson (Alternate) Debbi Meisner Deb Strickland Laurie Burckhardt Renee Juhn Gloria Davis Pete Anderson Web Mayfield X12C Liaison Deborah Brown n/a n/a Jan 2018 Jan 2018 Oct 2018 Jun 2018 Jan 2018 Jun 2018 Jun 2017 Appointed 1 election in June 2017 to fill the open term 1 election in Jun 2017 X12F Liaison Debra Strickland n/a Appointed X12M Liaison Merri-Lee Stine n/a Appointed PACDR SAC Laurie Burckhardt n/a Appointed SAD SAC International Association of Industrial Accident Boards & Commissions (IAIABC) Liaison Pete Anderson LuAnn Hetherington n/a Appointed Sherry Wilson n/a Appointed Cont X12 1

5 REPORT IN V 04/17 ORGANIZATION REPRESENTATIVE(S) TERM END DATE ELECTIONS CAQH CORE Liaison Lisa Miller n/a Appointed Workgroup for Electronic Data Interchange (WEDI) Liaison Stacey Barber n/a Appointed 2017 X12 2

6 TECH NICAL ASSESSMENT SUBCOMMITTEE (TAS) X12J Overview Maintains the X12.3 Data Element Dictionary, X12.22 Segment Directory, and X12 Design Rules and Guidelines. Processes, controls and coordinates requests for changes to the X12 EDI and XML standards and ensures that X12-approved design rules, guidelines and syntax rules are adhered to during the development and maintenance processes. Liaison LuAnn Hetherington, Primary (Appointed) Becky Kimmick, Alternate (Appointed) Meetings Standing Meetings: San Antonio June 5-7, 3:00-5:00 CT and June 12 3:00-5:00 ET Interim Meetings: Interim meeting held April 3-4, Next interim meeting August X12 3

7 TECH NICAL ASSESSMENT SUBCOMMITTEE (TAS) X12J Major Activities All documentation for this standing meeting is located on the X12N imeet space under the TAS June 2017 folder. Please see me for any items that need to go to TAS, questions pertaining to items at TAS or any other questions about TAS X12 4

8 PROCEDURES REVIEW BOARD (PRB) ASC X12 STEERING COMMITTEE Overview The purpose of the PRB is to ensure that due process was followed and consensus was reached in all ASC X12 standards, guidelines, and interpretations development and maintenance so that all participants have confidence in the fairness of the results. The PRB will not act on technical matters. Liaison Open, Primary Tim Pearson, Alternate Meetings Standing Meetings: June 14, 2017 Interim Meetings: None Scheduled 2017 X12 5

9 PROCEDURES REVIEW BOARD (PRB) ASC X12 STEERING COMMITTEE Major Activities From the prior Standing Meeting: Approved DMs from the October 2016 Data Maintenance Voting Package , , , , , , , Approved Type 3 Technical Reports , (X12N Premium Payment Grace Period Notification X344) Approved Code Maintenance Requests Batch 81- C17297 Batch 82- C C17317 Approved multiple project proposals :1 Since the prior Standing Meeting via imeet: None 2017 X12 6

10 FINANCE SUBCOMMITTEE (ASC X12F) Overview Purpose/Scope: Develops and maintains X12 EDI and XML standards including technical guidelines focusing on financial e-business models Develops and maintains financial business models related to areas such as credit card processes, financial remittance delivery, invoice, and payment transactions. Real estate and mortgage lending messages are also developed and maintained using EDI and XML standards. Develops payment systems architecture to include data security and data content management for financial standards Promotes the use of X12 EDI and XML standards across the financial services industry Liaison Debra Strickland Meetings Occurred: Upcoming: Joint Projects None 2017 X12 7

11 PROGRAM MANAGEMENT TASK GROUP ASC X12N/TGA Overview This group is responsible for: Overseeing the collection, prioritization and workflow management of change requests. Co-Chairs Debbi Meisner (February 2018) Deb Strickland (February 2018) Secretary Kelly Butler Task Group Elections There are no Task Group Co-Chair elections. Meetings Standing Meetings: This Task Group does not meet during Standing Meetings unless there are elections or items requiring a task group vote X12 8

12 PROGRAM MANAGEMENT TASK GROUP ASC X12N/TGA Work Group Co-Chairs Elections 1 Regulatory Advisory/Collaboration Annette Gabel Gail Kocher 2 Change Management Kelly Butler Penny Probst 3 Documentation Management Deb McCachern Open Position 4 Procedural Review and Education Deborah Brown Penny Probst No elections No elections No elections No elections 2017 X12 9

13 REGULATION ADVISORY/COLLABORATION X12N/TGA/WG1 Overview This group is responsible for: Writing and executing the policies, procedures, and processes necessary to keep X12's Insurance Subcommittee (X12N) synchronized with insurance activities: e.g., relations with other Designated Standards Maintenance Organizations (DSMO) DSMO change request processing NPRM technical comment questions and responses Regulatory compliance Co-Chairs Annette Gabel (October 2017) Gail Kocher (October 2018) Secretary Open Position Elections None X12 10

14 REGULATION ADVISORY/COLLABORATION X12N/TGA/WG1 Informational Forums TBD Likely canceled Cross Group Activities None. Meetings Standing Meetings: Interim Meetings: Third Wednesday every month, 4-5 PM Eastern Time Major Activities None X12 11

15 CHANGE MANAGEMENT X12N/TGA/WG2 Overview This group is responsible for: Reviewing, evaluating and prioritizing Change Requests submitted to X12 affecting existing and new X12N Technical Reports. Co-Chairs Kelly Butler (October 2018) Penny Probst (October 2017) Secretary Open Position Elections None X12 12

16 CHANGE MANAGEMENT 12N/TGA/WG2 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: This work group will not meet during the June Standing Meeting Interim Meetings: Every Wednesday 11:00 12:00 Eastern Time Major Activities Coordinated approval and assignment of change requests for X12N TR3s Since the last standing meeting TGAWG2 received 36 change requests. Of those, 14 were assigned to a primary business work group, 0 were canceled and 3 was rejected back to the submitter. There are a total of 242 open change requests, 154 are being processed by the primary TGB work group, 30 are in the approval process, 70 are ready for entry into OnlyConnect and 246 are complete X12 13

17 DOCUMENTATION MANAGEMENT X12N/TGA/WG3 Overview This group is responsible for: All documentation pertaining to policies and procedures for the X12N Subcommittee and its Task Groups and Work Groups including but not limited to X12N Standing Documents, Policy and Procedure Documents and Training Materials. Co-Chairs Deb McCachern (January 2019) Open Position Secretary Penny Probst (acting) Elections Tuesday, June 6 2:00 PM Central 2017 X12 14

18 DOCUMENTATION MANAGEMENT X12N/TGA/WG3 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Tues, June 6 2:00 PM Central Interim Meetings: Second Wednesday of the month, 3-4 PM Eastern Major Activities All meeting templates updated to conform to X12 standard template and logos Note: All meeting templates will be updated after Standing Meetings to reflect co-chair and liaison changes X12 15

19 PROCEDURAL REVIEW AND EDUCATION ASC X12N/TGA/WG4 Overview This group is responsible for: Establishing the guidelines and for ensuring procedures were followed for all work products developed in ASC X12N; creating and maintaining training materials; and developing the educational programs for ASC X12N. Co-Chairs Deborah Brown (January 2018) Penny Probst (June 2018) Secretary ***WE NEED YOU*** Elections None X12 16

20 PROCEDURAL REVIEW AND EDUCATION ASC X12N/TGA/WG4 Informational Forums Wednesday, 06/07/17, 2:00 3:00 PM CT: 820, Payroll Deducted and Other Group Premium Payment for Insurance Products (007030X334) and the 820, Health Insurance Exchange Related Payment (007030X345) Cross Group Activities None. Meetings Standing Meetings: Monday and Wednesday, 3:00 5:00 PM CT each day; Tuesday 3:00 4:00 PM CT Interim Meetings: TBD Major Activities Published the Public Review Process document Revised the Informational Forum Process document and posted for Approval Coordinated the public review period for the 837 TR3s (X323, X324, X325, and X326) Coordinated the informational forum for the 820 TR3s (X343 and X345) 2017 X12 17

21 BUSINESS TASK GROUP X12N/TGB Overview This group is responsible for: This group oversees the work of multiple workgroups in developing business requirements pertaining to industry request for change or new development. TGB assures coordination among the workgroups under TGB a well as the X12N Technical Group (TGC) including, but not limited to, technical reports and data standards. Co-Chairs Laurie Burckhardt (October 2018) Gloria Davis (January 2018) Secretary Tina Greene Task Group Elections None for Summer Standing Meeting Election for Fall Standing Meeting 2017 X12 18

22 BUSINESS TASK GROUP X12N/TGB Major Activities Full B meeting on Wednesday to approve new purpose & scope for TGB/WG2 and TGB/WG5 Workgroups are focusing on 7030 development or responding to comments 2017 X12 19

23 BUSINESS TASK GROUP X12N/TGB Work Group Co-Chairs Term End Date Scheduled Elections 1 Benefit Donna Campbell Agnes Dorio June 2017 June election in Jun Billing, Encounter, & Claim Attachment Chris Cioffi James Mosteller Lynn Chapple Vacated 3 Payment Pamela Grosze Pat Wijtyk Heather Morgan 4 Invoice and Premium Payment Dora Lambert Open Position Jun 2017 Jun 2017 Jan 2019 Oct 2017 Jun 2017 Jan 2018 Oct 2018 Jun elections in Jun election in Oct election in Jun elections in Jun Claim Status & Claim Acknowledgments Karen Shutt (convener) Mark Rabuffo (convener) 6 Entity Gail Kocher (convener) Debbi Meisner (convener) 2 elections in Oct 2017, will consider staggering 2 elections in Jun P&C Policy Administration Jeff Claycamp Kellie White Sue Mackenzie Jun 2017 Jun 2018 Jan election in Jun 2017 Cont X12 20

24 BUSINESS TASK GROUP X12N/TGB Work Group Co-Chairs Term End Date Scheduled Elections 8 Automobile Subrogation Not Active No elections 10 Services Review Bruce Bellefeuille Diane Franks Open Position 15 Provider Doreen Espinoza Betty Gomez Tom Mort 16 Enrollment Gail Kocher Tina Martinez Jun 2017 Jan 2019 Jun 2017 Jun 2018 Jun 2017 Oct 2017 Jan 2019 June elections in Jun election in Jun election in Jun X12 21

25 BUSINESS LIAISONS X12N/TGB Organization Dental Content Committee (DeCC) National Dental EDI Council (NDEDIC) Health Level 7 International (HL7) National Council for Prescription Drug Programs (NCPDP) Designated Standards Maintenance Organizations (DSMO) National Uniform Billing Committee (NUBC) National Uniform Claim Committee (NUCC) Insurance Industry Committee on Motor Vehicle Administration (ICMVA) Liaison Tom Mort Connor Carragher Tim McNeil Mary Lynam Stacey Barber, Primary Laurie Burckhardt,, Alternate Gail Kocher, Observer Laurie Burckhardt, Primary Debbi Meisner, Alternate Open, Technical Advisor Laurie Burckhardt, Primary Debbi Meisner, Alternate Open, Technical Advisor Angela Miller 2017 X12 22

26 BENEFIT INFORMATION X12N/TGB/WG1 Overview This group is responsible for: Creating, reviewing and maintaining (if applicable) business requirements that result from industry submitted change requests in addition to other X12N or X12N/TGB harmonization efforts as it relates to the eligibility and benefit information exchanged by or between any of the following: providers, clearinghouses, vendors and/or payers. Co-Chairs Aggie Dorio (June 2018) Donna Campbell (June 2017) Secretary Diane Rude (interim meetings only) Peggy Billhartz (standing meetings only) Elections Co-chair election, Monday, June 10 AM, 2-year term 2017 X12 23

27 BENEFIT INFORMATION X12N/TGB/WG1 Informational Forums None. Cross Group Activities WG1, 10 and 16 may meet depending on necessity. If a joint meeting is needed, the workgroups will meet in WG1 s room at 10 am Meetings Standing Meetings: See Agenda on WG1 Workspace. Date/Times outlined on WG1 Agenda Interim Meetings: First and Third Mondays, 2-4 PM Central, weekly on Tuesdays 3-4 PM Central (interim calls canceled while at a Standing Meeting) Major Activities WG1 will conduct a review of the X332 OnlyConnect TR3 WG1 will be working on the AAA codes that will need to be added to the TR X12 24

28 BILLING/ENCOUNTER & CLAIMS ATTACHMENT INFORMATION X12N/TGB/WG2 Overview This group is responsible for: Developing and managing the business requirements for claims, encounters, and claim attachment functionality (including but not limited to Health Care, Workers Compensation, Property and Casualty and Data reporting). Co-Chairs Chris Cioffi (June 2017) Jamie Mosteller (June 2017) Lynn Chapple (January 2019) Secretary Katie Sullivan Elections Elections Monday at 9:30 am 2017 X12 25

29 BILLING AND ENCOUNTER INFORMATION X12N/TGB/WG2 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Interim Meetings: 2nd and 4th Thursdays 1:00 2:30 EST Major Activities None X12 26

30 PAYMENT INFORMATION X12N/TGB/WG3 Overview This group is responsible for: Developing and managing business requirements for electronic data interchange standards related to the business of health care claim payment and payment verification. Co-Chairs Pam Grosze (June 2017) Pat Wijtyk (January 2018) Heather Morgan (October 2018) Secretary Open Elections Pam s Position Monday 1: X12 27

31 PAYMENT INFORMATION X12N/TGB/WG3 Informational Forums None. Cross Group Activities 837 COB Public Comment Responses Meetings Standing Meetings: Meet daily Interim Meetings: Every Wednesday and 2nd and 4th Mondays at 2:00 CT / 3:00 ET Major Activities Public Comment Responses all week CARC/RARC Tuesday morning RFI 2214 review 2017 X12 28

32 INVOICE AND PREMIUM PAYMENT INFORMATION X12N/TGB/WG4 Overview This group is responsible for: Bringing together Insurance industry representatives that will examine, develop, and maintain business requirements related to electronic data interchange standards of the Premium Payment transaction. Co-Chairs Dora Lambert (June 2017) Open Position Secretary Open Position Elections Monday, June 5 2:30 PM 2017 X12 29

33 INVOICE AND PREMIUM PAYMENT INFORMATION X12N/TGB/WG4 Informational Forums Wednesday, June 7 2:00 PM Cross Group Activities None. Meetings Standing Meetings: Monday Thursday, San Antonio Interim Meetings: Second and Fourth Wednesdays, 2:00 PM ET Major Activities Prepare for Info Forum Work on CRs Work on Examples 2017 X12 30

34 CLAIM STATUS AND CLAIM ACKNOWLEDGMENT ASC X12N/TGB/WG5 Overview This group is responsible for: Developing and managing the business requirements for claim status and claim acknowledgment functionality (including but not limited to Health Care, Workers Compensation, Property and Casualty). Co-Chairs Conveners: Karen Shutt Mark Rabuffo Secretary Cindy Monarch Elections September X12 31

35 CLAIM STATUS AND CLAIM ACKNOWLEDGMENT ASC X12N/TGB/WG5 Informational Forums None Cross Group Activities Meet with WG2 1:00) to hopefully finalize 7030 public comment on use of 277CA STC12 (Free form text element) Meetings Standing Meetings: M (9:30 5), T (8:30 5), W (9 5) Th. (8:30 11) Interim Meetings: TBD moving forward but have been meeting Tuesdays: 1:00 2:30 EST Major Activities 7030 Public Comment Adjudication 2017 X12 32

36 ENTITY INFORMATION X12N/TGB/WG6 Overview This group is responsible for: Identifying, documenting and maintaining business requirements used in the development, management and maintenance of information pertaining to entities (individuals and organizations) in the Standards and Technical Reports throughout all X12N transactions. Co-Chairs Gail Kocher (convener) Debbi Meisner (convener) Secretary Open Position Elections Wednesday 9:00 a.m. Central for both open co-chair positions 2017 X12 33

37 ENTITY INFORMATION X12N/TGB/WG6 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Wednesday at 9 am Interim Meetings: TBD Major Activities Review comments referred from public review 837 comments 9:15 a.m. Wednesday Open CRs 2017 X12 34

38 P&C POLICY ADMINISTRATION X12N/TGB/WG7 Overview This group is responsible for: Developing, managing, and maintaining the business requirements for insurance information exchanged between insurance companies and interested parties including third-party aggregates, state entities, and mortgage and automobile lenders. Co-Chairs Jeff Claycamp (June 2017) Kellie White (June 2018) Sue Mackenzie (January 2019) Secretary Ann Chittatil Elections Co-Chair Election for Jeff Claycamp (June 2017) on Tuesday, 6/6/17 at 2:30 p.m. (tentatively) in Neuces room X12 35

39 P&C POLICY ADMINISTRATION X12N/TGB/WG7 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: June 5 7 Interim Meetings: TDB, as needed Major Activities Continue discussion of new CR for Commercial Mortgage CR1464 Insurance carrier and lender/tracker request and response Review situational rules in the Mortgage Record Change Notification (266/824) CR1571 Create a new TR3 on Auto Insurance Notifications CR1340 Review of TR3 draft on SR filings 2017 X12 36

40 SERVICE REVIEW INFORMATION X12N/TGB/WG10 Overview This group is responsible for: Receiving and analyzing requests for new business functionality Developing the business requirements related to healthcare services utilization review events for referrals, authorizations, pre-certifications and notifications including the request and receiving of additional information to support the utilization review process. Co-Chairs Bruce Bellefeuille (June 2017) Diane Franks (January 2019) Secretary Theresa Doris Elections 2 Co-Chair positions available; Scheduled for Tuesday (6/6/2017) at 3PM 2017 X12 37

41 SERVICE REVIEW INFORMATION X12N/TGB/WG10 Informational Forums None. Cross Group Activities Service Type Code discussion with WG1/WG16 Host: WG1 Weds (10am-12pm) Meetings Standing Meetings: Mon (930-5), Tue (8-5), Weds (9-5), Thurs (9-12) Interim Meetings: 2nd and 4th Fridays 1:00-2:30 EST Major Activities Prepare for Public Comment activities Page turning exercise for all 278 transactions Continue working on remaining Change Requests 2017 X12 38

42 ENROLLMENT INFORMATION X12N/TGB/WG16 Overview This group is responsible for: Creating, reviewing and maintaining business requirements that are related to the business of insurance products enrollment and maintenance. Co-Chairs Gail Kocher (January 2019) Tina Martinez (June 2017) Secretary Open Position Elections Monday 9:45 a.m X12 39

43 ENROLLMENT INFORMATION X12N/TGB/WG16 Informational Forums None. Cross Group Activities With WG4 as needed for shared TR3 content Meetings Standing Meetings: Interim Meetings: 2nd & 4th Friday of every Month 11AM 12PM EST Major Activities Continue working on BRTS 2017 X12 40

44 DENTAL CONTENT COMMITTEE (DECC) Overview The DeCC is chaired by the American Dental Association (ADA) to cooperate in the maintenance of the standards adopted under HIPAA. The DeCC addresses standard transaction content on behalf of the dental health care community. Liaison Tom Mort (Appointed) Meetings Occurred: April 3, 2017 (virtual) Upcoming: August, (virtual) Joint Projects None 2017 X12 41

45 DENTAL CONTENT COMMITTEE (DECC) Major Activities Discussion of changes to the public comment process. Happy that PDF versions of the drafts were available. Last Discussion was around review of the 837 guides. Most comments were around the synchronization of the 837D with the other 837s 2017 X12 42

46 NATIONAL DENTAL EDI COUNCIL (NDEDIC) Overview The National Dental EDI Council (NDEDIC) is a not-for-profit association of diverse stakeholders working together to streamline dental business operations, reduce costs and improve patient service by effectively exchanging eligibility and claims data electronically. Liaison Connor Carragher Meetings Occurred: EDI Summit in May 2017 in Scottsdale, AZ Upcoming: Uniting the Industry Forum in October 2017 in Scottsdale, AZ EDI Summit in May 2018 in Austin, TX Joint Projects None 2017 X12 43

47 NATIONAL DENTAL EDI COUNCIL (NDEDIC) Major Activities Workgroups WG1: Top Dental Eligibility and Benefits Response Guide Enhanced to add frequency count and other miscellaneous edits Prepare for balloting WG2: Business Scenarios and CARC/RARC updates for dental Most commonly used dental CARCs and RARCs best practice definitions Task groups are new to NDEDIC, and they will begin meeting in June 2017 STC alignment with ADA common dental terminology codes and nomenclature Prior Authorization 2017 X12 44

48 HEALTH LEVEL 7 INTERNATIONAL (HL7) Overview HL7 is an ANSI-accredited standards organization dedicated to providing a comprehensive framework and related standards that supports clinical practice and the management, delivery and evaluation of health services. Liaison Tim McNeil (Appointed) Meetings Occurred: Out of Cycle meeting on 5/18 & 5/19, 2017 in Los Angeles, CA Upcoming: 9/9/17 thru 9/15/17 in San Diego, CA Joint Projects Attachment Collaboration Project (ACP) 2017 X12 45

49 HEALTH LEVEL 7 INTERNATIONAL (HL7) Major Activities During Out of Cycle Meeting in LA Held joint sessions with WEDI on presentation of an end to end automated attachment solution from a Provider, Clearinghouse and Payer prospective. Discussion on LOINC codes use in the response from a request for an Unstructured document of which there are 3 views: a. Select from document type = DOC (~8000) b. Select from database (~65000) c. Select from HIPAA panel (~80) Completed updates to Supplemental Guide and is ready to vote by work group to move forward with approval X12 46

50 NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) Overview NCPDP creates and promotes the transfer of data related to medications, supplies, and services within the healthcare system through the development of standards and industry guidance. Liaison Mary Lynam (Appointed) Meetings Occurred: May 2017 Phoenix, Arizona Upcoming: August 2 4 Minneapolis, Minnesota Joint Projects None 2017 X12 47

51 NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) Major Activities NCPDP 2/2017 balloted adjudicated. NCPDP will be recirculating and then once approved by NCPDP board will begin process to DSMO to replace current HIPAA version D.0. NCPDP RTBC (Real-Time Prescription Benefit) TG formed to begin process for creation of new NCPDP standard. NCPDP task groups NCPDP membership is not required. NCPDP 5/2017 New NCPDP board with next chairman John Hill of Argus Health Systems. New WG co-chair positions now in place beginning 5/ X12 48

52 DESIGNATED STANDARDS MAINTENANCE ORGANIZATION (DSMO) Overview The organizations that make up the DSMO agree to work together to manage the change request process affecting the transaction standards adopted by HHS under HIPAA. Currently this includes X12, DeCC, HL7, NCPDP, NUBC and NUCC. Liaison Laurie Burckhardt, Primary (Appointed) Stacey Barber, Alternate (Appointed) Gail Kocher, Observer (Appointed) Meetings Occurred: Upcoming: Joint Projects None No meetings No meetings scheduled at this time 2017 X12 49

53 DESIGNATED STANDARDS MAINTENANCE ORGANIZATION (DSMO) Major Activities None X12 50

54 NATIONAL UNIFORM BILLING COMMITTEE (NUBC) Overview The NUBC is chaired by the American Hospital Association (AHA) to cooperate in the maintenance of the standards adopted under HIPAA. The NUBC addresses standard transaction content on behalf of the institutional healthcare community. Liaison Laurie Burckhardt, Primary (Appointed) Debbi Meisner, Alternate (Appointed) Open Position, Technical Advisor Meetings Occurred: Upcoming: Joint Projects None April 4 & 5, 2017 in Chicago, IL August 8 & 9, 2017 in Baltimore, MD 2017 X12 51

55 NATIONAL UNIFORM BILLING COMMITTEE (NUBC) Major Activities Approved Occurrence Code 56 for Original Hospice Election or Revocation Date effective 1/1/2018 Note: Used when the hospice is submitting a correction to the election date reported on a previous 08xA Type of Bill or the revocation date on a previous 08xB Type of Bill. The hospice reports the correct dates in FL6 From/Through and the original date in this occurrence code. Status of Shorter Duration/More Frequent Hemodialysis Policy CMS doesn t have a policy for the codes as of yet. Therefore the effective date of 7/1/2017 will be modified to delayed, date to be determined Off-campus Provider Based Outpatient Departments (PBD) significant discussion with CMS to create an FAQ for NUBC to review and will be discussed in the near future X12 52

56 NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) Overview The NUCC is chaired by the American Medical Association (AMA) to cooperate in the maintenance of the standards adopted under HIPAA. The NUCC addresses standard transaction content on behalf of the professional healthcare community. Liaison Laurie Burckhardt, Primary (Appointed) Debbi Meisner, Alternate (Appointed) Open Position, Technical Advisor Meetings Occurred: Upcoming: Joint Projects None April 5, 2017 in Chicago, IL August 9, 2017 in Baltimore, MD 2017 X12 53

57 NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) Major Activities 1500 Instruction Manual has 2 changes for the instructions. Will be reviewing the manual to apply all changes since July 2016 with the expectation of manual to be released in July Taxonomy Code approved for Pediatric Ophthalmology and Strabismus Specialist under Allopathic & Osteopathic Physicians; Ophthalmology Reviewed 7030 draft 837 guides to determine if any comments should be submitted. One comment will be submitted which is to correct reference to Taxonomy code in section as well as to update the address for the code source X12 54

58 INSURANCE INDUSTRY COMMITTEE ON MOTOR VEHICLE ADMINISTRATION (IICMVA) Overview The Insurance Industry Committee on Motor Vehicle Administration (IICMVA) is an all-industry advisory group formed in January 1968 as the official liaison between the insurance industry and Motor Vehicle Departments in the US and Canada. The need for such a committee was identified when the American Association of Motor Vehicle Administrators (AAMVA) adopted a resolution that an industry committee be formed to work with motor vehicle administrators on matters affecting mutual interests. Liaison Angela Miller, State Farm (Appointed) Meetings Upcoming: San Antonio, June 7, 2017 from 9:00 to 10:00 AM Joint Projects None 09/26/ X12 55

59 INSURANCE INDUSTRY COMMITTEE ON MOTOR VEHICLE ADMINISTRATION (IICMVA) Major Activities A detailed report of the last IICMVA conference and various state jurisdiction activity will be presented by TGB/WG7 on Wednesday June 7, 2017 from 9:00 to 10:00 AM 09/26/ X12 56

60 TECHNICAL TASK GROUP X12N/TGC Overview This group is responsible for: The development and maintenance of work products including, but not limited to, technical reports and data standards. Co-Chairs Pete Anderson (June 2018) Web Mayfield (June 2017) Secretary Gloria Davis Task Group Elections One co-chair, 2-year term- Tuesday 1:30 PM 2017 X12 57

61 TECHNICAL TASK GROUP X12N/TGC Major Activities Consider updates to Technical Solution Principles Version transitions All TGC meetings are in Seguin 2017 X12 58

62 TECHNICAL TASK GROUP ASC X12N/TGC Work Group Co-Chairs Summer Elections TGC Pete Anderson (6/18) Web Mayfield (6/17) 2 RFI Mark Carter (1/19) Martin Wilbanks (1/18) 3 Solution Development Cindy Fiore (6/18) Kelly Butler (6/17) 4 Technical Design Becky Kimmick (10/18) Tim Pearson (10/17) 1 co-chair (6/19) Tuesday 1:30 None 1 co-chair (6/19) Tuesday 10:00 1 co-chair (10/18) Monday 10:00 None None None Fall Elections 1 co-chair (10/19) 5 Harmonization LuAnn Hetherington (10/17) Pat Wijtyk (1/18) 7 EDI Acknowledgments Deborah Brown (6/17) Jerry Sobotka (1/18) None 1 co-chair (10/19) 1 co-chair (6/19) Wednesday 9:00 None 2017 X12 59

63 REQUEST FOR INTERPRETATION (RFI) X12N/TGC/WG2 Overview This group is responsible for: Responding to Requests for Interpretation (RFI) assigned to X12N by the X12 Portal Screener. Coordinating with other X12N Groups as necessary to respond to RFIs assigned to X12N. Coordinating with other X12 subcommittees when X12N has interest in an RFI assigned to another sub-committee or when another subcommittee expresses interest in an RFI assigned to X12N. Co-Chairs Mark Carter (January 2019) Martin Wilbanks (January 2018) Secretary Kim Peters Elections None X12 60

64 REQUEST FOR INTERPRETATION (RFI) X12N/TGC/WG2 Informational Forums None. Cross Group Activities X12C shared RFI s (If necessary) Meetings Standing Meetings: Monday 4:00 5:00 PM - Sequin Wednesday 4:00 5:00 PM - Sequin Interim Meetings: All work is via online collaboration tool and Major Activities Review open RFI s 2017 X12 61

65 SOLUTION DEVELOPMENT X12N/TGC/WG3 Overview This group is responsible for: Identifying, and documenting technical solutions for all X12N work group change requests. Coordinating with X12N business work groups on all change requests. Entering technical solutions into OnlyConnect. Coordinating with the Technical Design work group (WG4) when DM/CMR may be required to complete a change request. Co-Chairs Cindy Fiore (June 2018) Kelly Butler (June 2017) Secretary Cindy Fiore (Acting) Elections Kelly Butlers position is open for election this standing meeting. Tuesday 6/6 10:00 Location: Seguin 2017 X12 62

66 SOLUTION DEVELOPMENT X12N/TGC/WG3 Informational Forums None. Cross Group Activities Meeting with TGC WG4 to review outstanding change requests that require DM/CMR. Meetings Standing Meetings: Tuesday 6/6 joint meeting with TGC WG4 from 8:30 10:00 am Tuesday 6/6 10:00am 11:00am Wednesday 6/7 11:00 12:00am Location: Seguin Interim Meetings: 1 st and 3 rd Tuesday of each month, 3 p.m. Eastern Time Major Activities None X12 63

67 TECHNICAL DESIGN ASC12N/TGC/WG4 Overview This group is responsible for: The group is responsible for the design, development and maintenance of work products including, but not limited to data standards. Co-Chairs Becky Kimmick (October 2018) Tim Pearson (October 2017) Secretary Please volunteer!! Elections Need to hold an election to replace Becky X12 64

68 TECHNICAL DESIGN ASC12N/TGC/WG4 Informational Forums None. Cross Group Activities Tues 6/6 8:30 AM 10:00 AM Sequin Technical Design Work Group - Joint w/ N C 03 Meetings Standing Meetings: Mon 6/5 10:00 AM 11:30 AM Sequin Tues 6/6 8:30 AM 10:00 AM Sequin Wed 6/7 3:00 PM 4:00 PM Sequin Thurs 6/8 9:00 AM 10:30 AM Sequin Available for meetings with workgroups as necessary. Contact co-chairs to arrange. becky.kimmick.jr2g@statefarm.com or TIM.PEARSON@palmettogba.com Major Activities Review open DM s and CMR s 2017 X12 65

69 HARMONIZATION X12N/TGC/WG5 Overview This group is responsible for: Ensuring the efficient exchange of business information for insurance including, but not limited to, Health Care and Property & Casualty. Ensuring compliance with X12 standards, design rules, and guidelines. Satisfying the functional business requirements established by other X12N Task Groups. Coordinating with the X12N liaisons where assigned and with other X12 Subcommittees, if applicable. Co-Chairs LuAnn Hetherington (October 2017) Pat Wijtyk (January 2018) Secretary Open Position Elections None X12 66

70 HARMONIZATION X12N/TGC/WG5 Informational Forums None. Cross Group Activities Public Comment Cycle 1 work groups to review terms and definitions Meetings Standing Meetings: Monday 2:00 3:00 and Wednesday 2:00-3:00 Interim Meetings: All work is via Central Desktop and - Wednesdays 1:00 2:00 ET Major Activities Common Content Terms and Definitions Public Comment Responses 2017 X12 67

71 EDI ACKNOWLEDGMENTS ASC X12N/TGC/WG7 Overview This group is responsible for: Developing and maintaining electronic data interchange standards related to the business of insurance transaction acknowledgments. Co-Chairs Deborah Brown (June 2017) Jerry Sobotka (January 2018) Secretary Jerry Sobotka (Acting) Elections Co-Chair Election at June 2017 Standing Meeting (Deborah Brown) 2017 X12 68

72 EDI ACKNOWLEDGMENTS ASC X12N/TGC/WG7 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Interim Meetings: 2:00 eastern. All work is via Central Desktop and Major Activities Draft Responses for Public Comments X12 69

73 POST ADJUDICATED CLAIMS DATA REPORTING (PACDR) X12N/SAC Overview The purpose of the Post Adjudicated Claim Data Reporting (PACDR) Special Appointed Committee is to facilitate an expedited development of implementation guides intended to standardize the process of exchanging PACDR related data as it relates to the Medicare and Medicaid encounter and All Payer Claims Database business processes. Liaison Laurie Burckhardt (Appointed) Penny Probst - Secretary Meetings Standing Meetings: Interim Meetings: Joint Projects None Not Meeting at June 2017 Standing Meeting 1 st & 3 rd Friday s of each month, 9:30 10:30 EST 2017 X12 70

74 POST ADJUDICATED CLAIMS DATA REPORTING (PACDR) ASCX12N/SAC Major Activities Working on development of PACDR Member Reporting Guide Due to 7030 work, the PACDR SAC hasn t been able to move forward with our 7030 work. This is expected to change for the second half of X12 71

75 INTERNATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT BOARDS & COMMISSIONS (IAIABC) Overview The purpose of the International Association of Industrial Accident Boards & Commissions (IAIABC) is to advance the efficiency and effectiveness of workers' compensation systems throughout the world. The IAIABC is a not-for-profit trade association representing government agencies charged with the administration of workers' compensation systems throughout the United States, Canada, and other nations and territories. Liaison Sherry Wilson (Appointed) Meetings Occurred: Spring Forum was in Kansas City, MO, April 24 27, 2017 Upcoming: Bi-monthly calls next July 12th; Annual Convention will be in Portland, OR, Oct. 2 5, 2017 Joint Projects None 2017 X12 72

76 INTERNATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT BOARDS & COMMISSIONS (IAIABC) Major Activities Tennessee : Working on EDI rules/implementation date 1/1/2018 for payers and tentatively 7/1/2018 for providers. Project to collect and manage state proprietary procedure codes (277CA, 835, 837) Updating companion guide and model rule template. State Mandated Attachment Regulation Initiatives States adopted in 2005 HIPAA proposed attachment regulations (Ack and 275) 12 years later states/waiting for attachment regulations Close MN will adopt Federal Attachment Regulations (275/6020) States on short hold - anticipating federal regs Stakeholder concerns - conflict between state and federal regs Advocating current version to meets the stakeholder business needs vs Review - Implementation Guides Significant impact to industry, mitigates the need for 50 state EDI Companion Guides. Major IAIABC and X12 joint achievement working across states for EDI collaboration Resource for Summary of State EDI Regulations for Worker s Compensation and Auto: (ebill) 2017 X12 73

77 WORKGROUP FOR ELECTRONIC DATA INTERCHANGE (WEDI) Overview The purpose of WEDI is to provide multi-stakeholder leadership and guidance to the healthcare industry on how to use and leverage the industry's collective technology, knowledge, expertise and information resources to improve the administrative efficiency, quality and cost effectiveness of healthcare information. Liaison Stacey Barber (Appointed) Meetings Occurred: January 31, Impact MACRA: Essential Strategies in Economic Reform WEBINAR February 14, Telehealth in the Spotlight: One state s comparison of billing and reimbursement regulations - WEBINAR March 1, st Century Cures Act Overview WEBINAR May 15 18, 2017 WEDI 2017 Los Angeles, CA Upcoming: August 1-2, Summer Forum Prior Authorization: Review, Realign, Reform, ADA Conference Center, Chicago, IL Meeting information available at wedi.org Joint Projects Attachments Collaboration Project (ACP) 2017 X12 74

78 WORKGROUP FOR ELECTRONIC DATA INTERCHANGE (WEDI) Major Activities WEDI Council On Prior Authorizations formed to address issues and burdens associated with Prior Authorizations. X12 invited to sit on the council X12 75

79 Full X12N Subcommittee Standing Meeting Agenda June 5 8, 2017 San Antonio, TX Stacey Barber, Chair Merri-Lee Stine, Vice Chair Penny Probst, Recording Secretary Gail Kocher, Administrative Secretary 2017 X12 1

80 DISCLAIMER This presentation is for informational purposes only. This presentation is not intended to represent legal advice. The content is point-in-time information, which is subject to revision. If you have questions regarding specific information shared during this presentation, please send them to Visit for additional details about X X12 2

81 INSURANCE SUBCOMMITTEE X12N Overview Develops and maintains X12 EDI and XML standards, standards interpretations and guidelines as they relate to all aspects of insurance and insurance-related business processes Includes development and maintenance activities relating to property, casualty, health care, life, annuity, reinsurance, pensions and reporting to regulatory agencies. Insurance Subcommittee initiatives also include all products and services, such as government health care programs like Medicare Serves as a liaison with complementary insurance standards bodies, such as HL7, to coordinate standards development activities Chairs Stacey Barber, Chair (January 2019) Merri-Lee Stine, Vice-Chair (January 2019) Secretary Gail Kocher, Administrative Secretary Penny Probst, Recording Secretary 2017 X12 3

82 MONDAY, JUNE 5, 2017, 8:00 AM ITEM AND PROPOSE Call Meeting to Order Introductions & First Time Attendees & Ground Rules Antitrust Statement and Recording Statement Announcements PERSON Stacey Barber Stacey Barber Gail Kocher Stacey Barber Logistics (Changes and Additions) Voting Items PACDR Project Proposals PRB Primary Rep Stacey Barber Laurie Burckhardt Stacey Barber Volunteerism Report In (Go to Next Slide) Merri-Lee Stine 2017 X12 4

83 ANTI-TRUST POLICY As a standards development organization accredited by the American National Standards Institute (ANSI), the Accredited Standards Committee (ASC) X12 shall conduct all of its activities in conformance with all applicable federal antitrust laws. The establishment of X12 electronic data interchange standards is an open process and subject to public domain. Items of particular importance and concern revolve around the following activities: Any effort undertaken, whether expressed or implied, that could be considered to restrain trade or act as a barrier to commerce to any individual or group of individuals shall be avoided. As in any activity where competitors in an industry are present, there shall be no discussion of pricing, whether of individual company prices, industry pricing policies, or plans of any company concerning specific products, customers, or territories. This is to avoid violation of anti-trust laws regarding price fixing and market division. Members must take special care to avoid making any statements or engaging in conduct prohibited by this policy. Responsibility for compliance rests with every X12 member and any invited guests or participants. If members have any doubt concerning propriety of any matters under discussion at such meetings, members shall report the matter to the Chair of the X12 Board or the Steering Chair. This notice shall be in effect during and concerning all activities of X12 and shall be read or referred to at the beginning of every X12 session X12 5

84 REPORT IN V 04/17 ORGANIZATION REPRESENTATIVE(S) TERM END DATE ELECTIONS Technical Assessment Subcommittee X12J (TAS) Procedures Review Board (PRB) Task Group A Program Management TGA WG and Liaison Report-Ins Task Group B Business TGB WG and Liaison Report-Ins Task Group C Technical TGC WG and Liaison Report-Ins LuAnn Hetherington Becky Kimmick Open Position (Representative) Tim Pearson (Alternate) Debbi Meisner Deb Strickland Laurie Burckhardt Renee Juhn Gloria Davis Pete Anderson Web Mayfield X12C Liaison Deborah Brown n/a n/a Jan 2018 Jan 2018 Oct 2018 Jun 2018 Jan 2018 Jun 2018 Jun 2017 Appointed 1 election in June 2017 to fill the open term 1 election in Jun 2017 X12F Liaison Debra Strickland n/a Appointed X12M Liaison Merri-Lee Stine n/a Appointed PACDR SAC Laurie Burckhardt n/a Appointed SAD SAC International Association of Industrial Accident Boards & Commissions (IAIABC) Liaison Pete Anderson LuAnn Hetherington n/a Appointed Sherry Wilson n/a Appointed Cont X12 6

85 REPORT IN V 04/17 ORGANIZATION REPRESENTATIVE(S) TERM END DATE ELECTIONS CAQH CORE Liaison Lisa Miller n/a Appointed Workgroup for Electronic Data Interchange (WEDI) Liaison Stacey Barber n/a Appointed 2017 X12 7

86 TECH NICAL ASSESSMENT SUBCOMMITTEE (TAS) X12J Overview Maintains the X12.3 Data Element Dictionary, X12.22 Segment Directory, and X12 Design Rules and Guidelines. Processes, controls and coordinates requests for changes to the X12 EDI and XML standards and ensures that X12-approved design rules, guidelines and syntax rules are adhered to during the development and maintenance processes. Liaison LuAnn Hetherington, Primary (Appointed) Becky Kimmick, Alternate (Appointed) Meetings Standing Meetings: San Antonio June 5-7, 3:00-5:00 CT and June 12 3:00-5:00 ET Interim Meetings: Interim meeting held April 3-4, Next interim meeting August X12 8

87 TECH NICAL ASSESSMENT SUBCOMMITTEE (TAS) X12J Major Activities All documentation for this standing meeting is located on the X12N imeet space under the TAS June 2017 folder. Please see me for any items that need to go to TAS, questions pertaining to items at TAS or any other questions about TAS X12 9

88 PROCEDURES REVIEW BOARD (PRB) ASC X12 STEERING COMMITTEE Overview The purpose of the PRB is to ensure that due process was followed and consensus was reached in all ASC X12 standards, guidelines, and interpretations development and maintenance so that all participants have confidence in the fairness of the results. The PRB will not act on technical matters. Liaison Open, Primary Tim Pearson, Alternate Meetings Standing Meetings: June 14, 2017 Interim Meetings: None Scheduled 2017 X12 10

89 PROCEDURES REVIEW BOARD (PRB) ASC X12 STEERING COMMITTEE Major Activities From the prior Standing Meeting: Approved DMs from the October 2016 Data Maintenance Voting Package , , , , , , , Approved Type 3 Technical Reports , (X12N Premium Payment Grace Period Notification X344) Approved Code Maintenance Requests Batch 81- C17297 Batch 82- C C17317 Approved multiple project proposals :1 Since the prior Standing Meeting via imeet: None 2017 X12 11

90 FINANCE SUBCOMMITTEE (ASC X12F) Overview Purpose/Scope: Develops and maintains X12 EDI and XML standards including technical guidelines focusing on financial e-business models Develops and maintains financial business models related to areas such as credit card processes, financial remittance delivery, invoice, and payment transactions. Real estate and mortgage lending messages are also developed and maintained using EDI and XML standards. Develops payment systems architecture to include data security and data content management for financial standards Promotes the use of X12 EDI and XML standards across the financial services industry Liaison Debra Strickland Meetings Occurred: Upcoming: Joint Projects None 2017 X12 12

91 PROGRAM MANAGEMENT TASK GROUP ASC X12N/TGA Overview This group is responsible for: Overseeing the collection, prioritization and workflow management of change requests. Co-Chairs Debbi Meisner (February 2018) Deb Strickland (February 2018) Secretary Kelly Butler Task Group Elections There are no Task Group Co-Chair elections. Meetings Standing Meetings: This Task Group does not meet during Standing Meetings unless there are elections or items requiring a task group vote X12 13

92 PROGRAM MANAGEMENT TASK GROUP ASC X12N/TGA Work Group Co-Chairs Elections 1 Regulatory Advisory/Collaboration Annette Gabel Gail Kocher 2 Change Management Kelly Butler Penny Probst 3 Documentation Management Deb McCachern Open Position 4 Procedural Review and Education Deborah Brown Penny Probst No elections No elections No elections No elections 2017 X12 14

93 REGULATION ADVISORY/COLLABORATION X12N/TGA/WG1 Overview This group is responsible for: Writing and executing the policies, procedures, and processes necessary to keep X12's Insurance Subcommittee (X12N) synchronized with insurance activities: e.g., relations with other Designated Standards Maintenance Organizations (DSMO) DSMO change request processing NPRM technical comment questions and responses Regulatory compliance Co-Chairs Annette Gabel (October 2017) Gail Kocher (October 2018) Secretary Open Position Elections None X12 15

94 REGULATION ADVISORY/COLLABORATION X12N/TGA/WG1 Informational Forums TBD Likely canceled Cross Group Activities None. Meetings Standing Meetings: Interim Meetings: Third Wednesday every month, 4-5 PM Eastern Time Major Activities None X12 16

95 CHANGE MANAGEMENT X12N/TGA/WG2 Overview This group is responsible for: Reviewing, evaluating and prioritizing Change Requests submitted to X12 affecting existing and new X12N Technical Reports. Co-Chairs Kelly Butler (October 2018) Penny Probst (October 2017) Secretary Open Position Elections None X12 17

96 CHANGE MANAGEMENT 12N/TGA/WG2 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: This work group will not meet during the June Standing Meeting Interim Meetings: Every Wednesday 11:00 12:00 Eastern Time Major Activities Coordinated approval and assignment of change requests for X12N TR3s Since the last standing meeting TGAWG2 received 36 change requests. Of those, 14 were assigned to a primary business work group, 0 were canceled and 3 was rejected back to the submitter. There are a total of 242 open change requests, 154 are being processed by the primary TGB work group, 30 are in the approval process, 70 are ready for entry into OnlyConnect and 246 are complete X12 18

97 DOCUMENTATION MANAGEMENT X12N/TGA/WG3 Overview This group is responsible for: All documentation pertaining to policies and procedures for the X12N Subcommittee and its Task Groups and Work Groups including but not limited to X12N Standing Documents, Policy and Procedure Documents and Training Materials. Co-Chairs Deb McCachern (January 2019) Open Position Secretary Penny Probst (acting) Elections Tuesday, June 6 2:00 PM Central 2017 X12 19

98 DOCUMENTATION MANAGEMENT X12N/TGA/WG3 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Tues, June 6 2:00 PM Central Interim Meetings: Second Wednesday of the month, 3-4 PM Eastern Major Activities All meeting templates updated to conform to X12 standard template and logos Note: All meeting templates will be updated after Standing Meetings to reflect co-chair and liaison changes X12 20

99 PROCEDURAL REVIEW AND EDUCATION ASC X12N/TGA/WG4 Overview This group is responsible for: Establishing the guidelines and for ensuring procedures were followed for all work products developed in ASC X12N; creating and maintaining training materials; and developing the educational programs for ASC X12N. Co-Chairs Deborah Brown (January 2018) Penny Probst (June 2018) Secretary ***WE NEED YOU*** Elections None X12 21

100 PROCEDURAL REVIEW AND EDUCATION ASC X12N/TGA/WG4 Informational Forums Wednesday, 06/07/17, 2:00 3:00 PM CT: 820, Payroll Deducted and Other Group Premium Payment for Insurance Products (007030X334) and the 820, Health Insurance Exchange Related Payment (007030X345) Cross Group Activities None. Meetings Standing Meetings: Monday and Wednesday, 3:00 5:00 PM CT each day; Tuesday 3:00 4:00 PM CT Interim Meetings: TBD Major Activities Published the Public Review Process document Revised the Informational Forum Process document and posted for Approval Coordinated the public review period for the 837 TR3s (X323, X324, X325, and X326) Coordinated the informational forum for the 820 TR3s (X343 and X345) 2017 X12 22

101 BUSINESS TASK GROUP X12N/TGB Overview This group is responsible for: This group oversees the work of multiple workgroups in developing business requirements pertaining to industry request for change or new development. TGB assures coordination among the workgroups under TGB a well as the X12N Technical Group (TGC) including, but not limited to, technical reports and data standards. Co-Chairs Laurie Burckhardt (October 2018) Gloria Davis (January 2018) Secretary Tina Greene Task Group Elections None for Summer Standing Meeting Election for Fall Standing Meeting 2017 X12 23

102 BUSINESS TASK GROUP X12N/TGB Major Activities Full B meeting on Wednesday to approve new purpose & scope for TGB/WG2 and TGB/WG5 Workgroups are focusing on 7030 development or responding to comments 2017 X12 24

103 BUSINESS TASK GROUP X12N/TGB Work Group Co-Chairs Term End Date Scheduled Elections 1 Benefit Donna Campbell Agnes Dorio June 2017 June election in Jun Billing, Encounter, & Claim Attachment Chris Cioffi James Mosteller Lynn Chapple Vacated 3 Payment Pamela Grosze Pat Wijtyk Heather Morgan 4 Invoice and Premium Payment Dora Lambert Open Position Jun 2017 Jun 2017 Jan 2019 Oct 2017 Jun 2017 Jan 2018 Oct 2018 Jun elections in Jun election in Oct election in Jun elections in Jun Claim Status & Claim Acknowledgments Karen Shutt (convener) Mark Rabuffo (convener) 6 Entity Gail Kocher (convener) Debbi Meisner (convener) 2 elections in Oct 2017, will consider staggering 2 elections in Jun P&C Policy Administration Jeff Claycamp Kellie White Sue Mackenzie Jun 2017 Jun 2018 Jan election in Jun 2017 Cont X12 25

104 BUSINESS TASK GROUP X12N/TGB Work Group Co-Chairs Term End Date Scheduled Elections 8 Automobile Subrogation Not Active No elections 10 Services Review Bruce Bellefeuille Diane Franks Open Position 15 Provider Doreen Espinoza Betty Gomez Tom Mort 16 Enrollment Gail Kocher Tina Martinez Jun 2017 Jan 2019 Jun 2017 Jun 2018 Jun 2017 Oct 2017 Jan 2019 June elections in Jun election in Jun election in Jun X12 26

105 BUSINESS LIAISONS X12N/TGB Organization Dental Content Committee (DeCC) National Dental EDI Council (NDEDIC) Health Level 7 International (HL7) National Council for Prescription Drug Programs (NCPDP) Designated Standards Maintenance Organizations (DSMO) National Uniform Billing Committee (NUBC) National Uniform Claim Committee (NUCC) Insurance Industry Committee on Motor Vehicle Administration (ICMVA) Liaison Tom Mort Connor Carragher Tim McNeil Mary Lynam Stacey Barber, Primary Laurie Burckhardt,, Alternate Gail Kocher, Observer Laurie Burckhardt, Primary Debbi Meisner, Alternate Open, Technical Advisor Laurie Burckhardt, Primary Debbi Meisner, Alternate Open, Technical Advisor Angela Miller 2017 X12 27

106 BENEFIT INFORMATION X12N/TGB/WG1 Overview This group is responsible for: Creating, reviewing and maintaining (if applicable) business requirements that result from industry submitted change requests in addition to other X12N or X12N/TGB harmonization efforts as it relates to the eligibility and benefit information exchanged by or between any of the following: providers, clearinghouses, vendors and/or payers. Co-Chairs Aggie Dorio (June 2018) Donna Campbell (June 2017) Secretary Diane Rude (interim meetings only) Peggy Billhartz (standing meetings only) Elections Co-chair election, Monday, June 10 AM, 2-year term 2017 X12 28

107 BENEFIT INFORMATION X12N/TGB/WG1 Informational Forums None. Cross Group Activities WG1, 10 and 16 may meet depending on necessity. If a joint meeting is needed, the workgroups will meet in WG1 s room at 10 am Meetings Standing Meetings: See Agenda on WG1 Workspace. Date/Times outlined on WG1 Agenda Interim Meetings: First and Third Mondays, 2-4 PM Central, weekly on Tuesdays 3-4 PM Central (interim calls canceled while at a Standing Meeting) Major Activities WG1 will conduct a review of the X332 OnlyConnect TR3 WG1 will be working on the AAA codes that will need to be added to the TR X12 29

108 BILLING/ENCOUNTER & CLAIMS ATTACHMENT INFORMATION X12N/TGB/WG2 Overview This group is responsible for: Developing and managing the business requirements for claims, encounters, and claim attachment functionality (including but not limited to Health Care, Workers Compensation, Property and Casualty and Data reporting). Co-Chairs Chris Cioffi (June 2017) Jamie Mosteller (June 2017) Lynn Chapple (January 2019) Secretary Katie Sullivan Elections Elections Monday at 9:30 am 2017 X12 30

109 BILLING AND ENCOUNTER INFORMATION X12N/TGB/WG2 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Interim Meetings: 2nd and 4th Thursdays 1:00 2:30 EST Major Activities None X12 31

110 PAYMENT INFORMATION X12N/TGB/WG3 Overview This group is responsible for: Developing and managing business requirements for electronic data interchange standards related to the business of health care claim payment and payment verification. Co-Chairs Pam Grosze (June 2017) Pat Wijtyk (January 2018) Heather Morgan (October 2018) Secretary Open Elections Pam s Position Monday 1: X12 32

111 PAYMENT INFORMATION X12N/TGB/WG3 Informational Forums None. Cross Group Activities 837 COB Public Comment Responses Meetings Standing Meetings: Meet daily Interim Meetings: Every Wednesday and 2nd and 4th Mondays at 2:00 CT / 3:00 ET Major Activities Public Comment Responses all week CARC/RARC Tuesday morning RFI 2214 review 2017 X12 33

112 INVOICE AND PREMIUM PAYMENT INFORMATION X12N/TGB/WG4 Overview This group is responsible for: Bringing together Insurance industry representatives that will examine, develop, and maintain business requirements related to electronic data interchange standards of the Premium Payment transaction. Co-Chairs Dora Lambert (June 2017) Open Position Secretary Open Position Elections Monday, June 5 2:30 PM 2017 X12 34

113 INVOICE AND PREMIUM PAYMENT INFORMATION X12N/TGB/WG4 Informational Forums Wednesday, June 7 2:00 PM Cross Group Activities None. Meetings Standing Meetings: Monday Thursday, San Antonio Interim Meetings: Second and Fourth Wednesdays, 2:00 PM ET Major Activities Prepare for Info Forum Work on CRs Work on Examples 2017 X12 35

114 CLAIM STATUS AND CLAIM ACKNOWLEDGMENT ASC X12N/TGB/WG5 Overview This group is responsible for: Developing and managing the business requirements for claim status and claim acknowledgment functionality (including but not limited to Health Care, Workers Compensation, Property and Casualty). Co-Chairs Conveners: Karen Shutt Mark Rabuffo Secretary Cindy Monarch Elections September X12 36

115 CLAIM STATUS AND CLAIM ACKNOWLEDGMENT ASC X12N/TGB/WG5 Informational Forums None Cross Group Activities Meet with WG2 1:00) to hopefully finalize 7030 public comment on use of 277CA STC12 (Free form text element) Meetings Standing Meetings: M (9:30 5), T (8:30 5), W (9 5) Th. (8:30 11) Interim Meetings: TBD moving forward but have been meeting Tuesdays: 1:00 2:30 EST Major Activities 7030 Public Comment Adjudication 2017 X12 37

116 ENTITY INFORMATION X12N/TGB/WG6 Overview This group is responsible for: Identifying, documenting and maintaining business requirements used in the development, management and maintenance of information pertaining to entities (individuals and organizations) in the Standards and Technical Reports throughout all X12N transactions. Co-Chairs Gail Kocher (convener) Debbi Meisner (convener) Secretary Open Position Elections Wednesday 9:00 a.m. Central for both open co-chair positions 2017 X12 38

117 ENTITY INFORMATION X12N/TGB/WG6 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Wednesday at 9 am Interim Meetings: TBD Major Activities Review comments referred from public review 837 comments 9:15 a.m. Wednesday Open CRs 2017 X12 39

118 P&C POLICY ADMINISTRATION X12N/TGB/WG7 Overview This group is responsible for: Developing, managing, and maintaining the business requirements for insurance information exchanged between insurance companies and interested parties including third-party aggregates, state entities, and mortgage and automobile lenders. Co-Chairs Jeff Claycamp (June 2017) Kellie White (June 2018) Sue Mackenzie (January 2019) Secretary Ann Chittatil Elections Co-Chair Election for Jeff Claycamp (June 2017) on Tuesday, 6/6/17 at 2:30 p.m. (tentatively) in Neuces room X12 40

119 P&C POLICY ADMINISTRATION X12N/TGB/WG7 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: June 5 7 Interim Meetings: TDB, as needed Major Activities Continue discussion of new CR for Commercial Mortgage CR1464 Insurance carrier and lender/tracker request and response Review situational rules in the Mortgage Record Change Notification (266/824) CR1571 Create a new TR3 on Auto Insurance Notifications CR1340 Review of TR3 draft on SR filings 2017 X12 41

120 SERVICE REVIEW INFORMATION X12N/TGB/WG10 Overview This group is responsible for: Receiving and analyzing requests for new business functionality Developing the business requirements related to healthcare services utilization review events for referrals, authorizations, pre-certifications and notifications including the request and receiving of additional information to support the utilization review process. Co-Chairs Bruce Bellefeuille (June 2017) Diane Franks (January 2019) Secretary Theresa Doris Elections 2 Co-Chair positions available; Scheduled for Tuesday (6/6/2017) at 3PM 2017 X12 42

121 SERVICE REVIEW INFORMATION X12N/TGB/WG10 Informational Forums None. Cross Group Activities Service Type Code discussion with WG1/WG16 Host: WG1 Weds (10am-12pm) Meetings Standing Meetings: Mon (930-5), Tue (8-5), Weds (9-5), Thurs (9-12) Interim Meetings: 2nd and 4th Fridays 1:00-2:30 EST Major Activities Prepare for Public Comment activities Page turning exercise for all 278 transactions Continue working on remaining Change Requests 2017 X12 43

122 ENROLLMENT INFORMATION X12N/TGB/WG16 Overview This group is responsible for: Creating, reviewing and maintaining business requirements that are related to the business of insurance products enrollment and maintenance. Co-Chairs Gail Kocher (January 2019) Tina Martinez (June 2017) Secretary Open Position Elections Monday 9:45 a.m X12 44

123 ENROLLMENT INFORMATION X12N/TGB/WG16 Informational Forums None. Cross Group Activities With WG4 as needed for shared TR3 content Meetings Standing Meetings: Interim Meetings: 2nd & 4th Friday of every Month 11AM 12PM EST Major Activities Continue working on BRTS 2017 X12 45

124 DENTAL CONTENT COMMITTEE (DECC) Overview The DeCC is chaired by the American Dental Association (ADA) to cooperate in the maintenance of the standards adopted under HIPAA. The DeCC addresses standard transaction content on behalf of the dental health care community. Liaison Tom Mort (Appointed) Meetings Occurred: April 3, 2017 (virtual) Upcoming: August, (virtual) Joint Projects None 2017 X12 46

125 DENTAL CONTENT COMMITTEE (DECC) Major Activities Discussion of changes to the public comment process. Happy that PDF versions of the drafts were available. Last Discussion was around review of the 837 guides. Most comments were around the synchronization of the 837D with the other 837s 2017 X12 47

126 NATIONAL DENTAL EDI COUNCIL (NDEDIC) Overview The National Dental EDI Council (NDEDIC) is a not-for-profit association of diverse stakeholders working together to streamline dental business operations, reduce costs and improve patient service by effectively exchanging eligibility and claims data electronically. Liaison Connor Carragher Meetings Occurred: EDI Summit in May 2017 in Scottsdale, AZ Upcoming: Uniting the Industry Forum in October 2017 in Scottsdale, AZ EDI Summit in May 2018 in Austin, TX Joint Projects None 2017 X12 48

127 NATIONAL DENTAL EDI COUNCIL (NDEDIC) Major Activities Workgroups WG1: Top Dental Eligibility and Benefits Response Guide Enhanced to add frequency count and other miscellaneous edits Prepare for balloting WG2: Business Scenarios and CARC/RARC updates for dental Most commonly used dental CARCs and RARCs best practice definitions Task groups are new to NDEDIC, and they will begin meeting in June 2017 STC alignment with ADA common dental terminology codes and nomenclature Prior Authorization 2017 X12 49

128 HEALTH LEVEL 7 INTERNATIONAL (HL7) Overview HL7 is an ANSI-accredited standards organization dedicated to providing a comprehensive framework and related standards that supports clinical practice and the management, delivery and evaluation of health services. Liaison Tim McNeil (Appointed) Meetings Occurred: Out of Cycle meeting on 5/18 & 5/19, 2017 in Los Angeles, CA Upcoming: 9/9/17 thru 9/15/17 in San Diego, CA Joint Projects Attachment Collaboration Project (ACP) 2017 X12 50

129 HEALTH LEVEL 7 INTERNATIONAL (HL7) Major Activities During Out of Cycle Meeting in LA Held joint sessions with WEDI on presentation of an end to end automated attachment solution from a Provider, Clearinghouse and Payer prospective. Discussion on LOINC codes use in the response from a request for an Unstructured document of which there are 3 views: a. Select from document type = DOC (~8000) b. Select from database (~65000) c. Select from HIPAA panel (~80) Completed updates to Supplemental Guide and is ready to vote by work group to move forward with approval X12 51

130 NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) Overview NCPDP creates and promotes the transfer of data related to medications, supplies, and services within the healthcare system through the development of standards and industry guidance. Liaison Mary Lynam (Appointed) Meetings Occurred: May 2017 Phoenix, Arizona Upcoming: August 2 4 Minneapolis, Minnesota Joint Projects None 2017 X12 52

131 NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) Major Activities NCPDP 2/2017 balloted adjudicated. NCPDP will be recirculating and then once approved by NCPDP board will begin process to DSMO to replace current HIPAA version D.0. NCPDP RTBC (Real-Time Prescription Benefit) TG formed to begin process for creation of new NCPDP standard. NCPDP task groups NCPDP membership is not required. NCPDP 5/2017 New NCPDP board with next chairman John Hill of Argus Health Systems. New WG co-chair positions now in place beginning 5/ X12 53

132 DESIGNATED STANDARDS MAINTENANCE ORGANIZATION (DSMO) Overview The organizations that make up the DSMO agree to work together to manage the change request process affecting the transaction standards adopted by HHS under HIPAA. Currently this includes X12, DeCC, HL7, NCPDP, NUBC and NUCC. Liaison Laurie Burckhardt, Primary (Appointed) Stacey Barber, Alternate (Appointed) Gail Kocher, Observer (Appointed) Meetings Occurred: Upcoming: Joint Projects None No meetings No meetings scheduled at this time 2017 X12 54

133 DESIGNATED STANDARDS MAINTENANCE ORGANIZATION (DSMO) Major Activities None X12 55

134 NATIONAL UNIFORM BILLING COMMITTEE (NUBC) Overview The NUBC is chaired by the American Hospital Association (AHA) to cooperate in the maintenance of the standards adopted under HIPAA. The NUBC addresses standard transaction content on behalf of the institutional healthcare community. Liaison Laurie Burckhardt, Primary (Appointed) Debbi Meisner, Alternate (Appointed) Open Position, Technical Advisor Meetings Occurred: Upcoming: Joint Projects None April 4 & 5, 2017 in Chicago, IL August 8 & 9, 2017 in Baltimore, MD 2017 X12 56

135 NATIONAL UNIFORM BILLING COMMITTEE (NUBC) Major Activities Approved Occurrence Code 56 for Original Hospice Election or Revocation Date effective 1/1/2018 Note: Used when the hospice is submitting a correction to the election date reported on a previous 08xA Type of Bill or the revocation date on a previous 08xB Type of Bill. The hospice reports the correct dates in FL6 From/Through and the original date in this occurrence code. Status of Shorter Duration/More Frequent Hemodialysis Policy CMS doesn t have a policy for the codes as of yet. Therefore the effective date of 7/1/2017 will be modified to delayed, date to be determined Off-campus Provider Based Outpatient Departments (PBD) significant discussion with CMS to create an FAQ for NUBC to review and will be discussed in the near future X12 57

136 NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) Overview The NUCC is chaired by the American Medical Association (AMA) to cooperate in the maintenance of the standards adopted under HIPAA. The NUCC addresses standard transaction content on behalf of the professional healthcare community. Liaison Laurie Burckhardt, Primary (Appointed) Debbi Meisner, Alternate (Appointed) Open Position, Technical Advisor Meetings Occurred: Upcoming: Joint Projects None April 5, 2017 in Chicago, IL August 9, 2017 in Baltimore, MD 2017 X12 58

137 NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) Major Activities 1500 Instruction Manual has 2 changes for the instructions. Will be reviewing the manual to apply all changes since July 2016 with the expectation of manual to be released in July Taxonomy Code approved for Pediatric Ophthalmology and Strabismus Specialist under Allopathic & Osteopathic Physicians; Ophthalmology Reviewed 7030 draft 837 guides to determine if any comments should be submitted. One comment will be submitted which is to correct reference to Taxonomy code in section as well as to update the address for the code source X12 59

138 INSURANCE INDUSTRY COMMITTEE ON MOTOR VEHICLE ADMINISTRATION (IICMVA) Overview The Insurance Industry Committee on Motor Vehicle Administration (IICMVA) is an all-industry advisory group formed in January 1968 as the official liaison between the insurance industry and Motor Vehicle Departments in the US and Canada. The need for such a committee was identified when the American Association of Motor Vehicle Administrators (AAMVA) adopted a resolution that an industry committee be formed to work with motor vehicle administrators on matters affecting mutual interests. Liaison Angela Miller, State Farm (Appointed) Meetings Upcoming: San Antonio, June 7, 2017 from 9:00 to 10:00 AM Joint Projects None 09/26/ X12 60

139 INSURANCE INDUSTRY COMMITTEE ON MOTOR VEHICLE ADMINISTRATION (IICMVA) Major Activities A detailed report of the last IICMVA conference and various state jurisdiction activity will be presented by TGB/WG7 on Wednesday June 7, 2017 from 9:00 to 10:00 AM 09/26/ X12 61

140 TECHNICAL TASK GROUP X12N/TGC Overview This group is responsible for: The development and maintenance of work products including, but not limited to, technical reports and data standards. Co-Chairs Pete Anderson (June 2018) Web Mayfield (June 2017) Secretary Gloria Davis Task Group Elections One co-chair, 2-year term- Tuesday 1:30 PM 2017 X12 62

141 TECHNICAL TASK GROUP X12N/TGC Major Activities Consider updates to Technical Solution Principles Version transitions All TGC meetings are in Seguin 2017 X12 63

142 TECHNICAL TASK GROUP ASC X12N/TGC Work Group Co-Chairs Summer Elections TGC Pete Anderson (6/18) Web Mayfield (6/17) 2 RFI Mark Carter (1/19) Martin Wilbanks (1/18) 3 Solution Development Cindy Fiore (6/18) Kelly Butler (6/17) 4 Technical Design Becky Kimmick (10/18) Tim Pearson (10/17) 1 co-chair (6/19) Tuesday 1:30 None 1 co-chair (6/19) Tuesday 10:00 1 co-chair (10/18) Monday 10:00 None None None Fall Elections 1 co-chair (10/19) 5 Harmonization LuAnn Hetherington (10/17) Pat Wijtyk (1/18) 7 EDI Acknowledgments Deborah Brown (6/17) Jerry Sobotka (1/18) None 1 co-chair (10/19) 1 co-chair (6/19) Wednesday 9:00 None 2017 X12 64

143 REQUEST FOR INTERPRETATION (RFI) X12N/TGC/WG2 Overview This group is responsible for: Responding to Requests for Interpretation (RFI) assigned to X12N by the X12 Portal Screener. Coordinating with other X12N Groups as necessary to respond to RFIs assigned to X12N. Coordinating with other X12 subcommittees when X12N has interest in an RFI assigned to another sub-committee or when another subcommittee expresses interest in an RFI assigned to X12N. Co-Chairs Mark Carter (January 2019) Martin Wilbanks (January 2018) Secretary Kim Peters Elections None X12 65

144 REQUEST FOR INTERPRETATION (RFI) X12N/TGC/WG2 Informational Forums None. Cross Group Activities X12C shared RFI s (If necessary) Meetings Standing Meetings: Monday 4:00 5:00 PM - Sequin Wednesday 4:00 5:00 PM - Sequin Interim Meetings: All work is via online collaboration tool and Major Activities Review open RFI s 2017 X12 66

145 SOLUTION DEVELOPMENT X12N/TGC/WG3 Overview This group is responsible for: Identifying, and documenting technical solutions for all X12N work group change requests. Coordinating with X12N business work groups on all change requests. Entering technical solutions into OnlyConnect. Coordinating with the Technical Design work group (WG4) when DM/CMR may be required to complete a change request. Co-Chairs Cindy Fiore (June 2018) Kelly Butler (June 2017) Secretary Cindy Fiore (Acting) Elections Kelly Butlers position is open for election this standing meeting. Tuesday 6/6 10:00 Location: Seguin 2017 X12 67

146 SOLUTION DEVELOPMENT X12N/TGC/WG3 Informational Forums None. Cross Group Activities Meeting with TGC WG4 to review outstanding change requests that require DM/CMR. Meetings Standing Meetings: Tuesday 6/6 joint meeting with TGC WG4 from 8:30 10:00 am Tuesday 6/6 10:00am 11:00am Wednesday 6/7 11:00 12:00am Location: Seguin Interim Meetings: 1 st and 3 rd Tuesday of each month, 3 p.m. Eastern Time Major Activities None X12 68

147 TECHNICAL DESIGN ASC12N/TGC/WG4 Overview This group is responsible for: The group is responsible for the design, development and maintenance of work products including, but not limited to data standards. Co-Chairs Becky Kimmick (October 2018) Tim Pearson (October 2017) Secretary Please volunteer!! Elections Need to hold an election to replace Becky X12 69

148 TECHNICAL DESIGN ASC12N/TGC/WG4 Informational Forums None. Cross Group Activities Tues 6/6 8:30 AM 10:00 AM Sequin Technical Design Work Group - Joint w/ N C 03 Meetings Standing Meetings: Mon 6/5 10:00 AM 11:30 AM Sequin Tues 6/6 8:30 AM 10:00 AM Sequin Wed 6/7 3:00 PM 4:00 PM Sequin Thurs 6/8 9:00 AM 10:30 AM Sequin Available for meetings with workgroups as necessary. Contact co-chairs to arrange. becky.kimmick.jr2g@statefarm.com or TIM.PEARSON@palmettogba.com Major Activities Review open DM s and CMR s 2017 X12 70

149 HARMONIZATION X12N/TGC/WG5 Overview This group is responsible for: Ensuring the efficient exchange of business information for insurance including, but not limited to, Health Care and Property & Casualty. Ensuring compliance with X12 standards, design rules, and guidelines. Satisfying the functional business requirements established by other X12N Task Groups. Coordinating with the X12N liaisons where assigned and with other X12 Subcommittees, if applicable. Co-Chairs LuAnn Hetherington (October 2017) Pat Wijtyk (January 2018) Secretary Open Position Elections None X12 71

150 HARMONIZATION X12N/TGC/WG5 Informational Forums None. Cross Group Activities Public Comment Cycle 1 work groups to review terms and definitions Meetings Standing Meetings: Monday 2:00 3:00 and Wednesday 2:00-3:00 Interim Meetings: All work is via Central Desktop and - Wednesdays 1:00 2:00 ET Major Activities Common Content Terms and Definitions Public Comment Responses 2017 X12 72

151 EDI ACKNOWLEDGMENTS ASC X12N/TGC/WG7 Overview This group is responsible for: Developing and maintaining electronic data interchange standards related to the business of insurance transaction acknowledgments. Co-Chairs Deborah Brown (June 2017) Jerry Sobotka (January 2018) Secretary Jerry Sobotka (Acting) Elections Co-Chair Election at June 2017 Standing Meeting (Deborah Brown) 2017 X12 73

152 EDI ACKNOWLEDGMENTS ASC X12N/TGC/WG7 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Interim Meetings: 2:00 eastern. All work is via Central Desktop and Major Activities Draft Responses for Public Comments X12 74

153 POST ADJUDICATED CLAIMS DATA REPORTING (PACDR) X12N/SAC Overview The purpose of the Post Adjudicated Claim Data Reporting (PACDR) Special Appointed Committee is to facilitate an expedited development of implementation guides intended to standardize the process of exchanging PACDR related data as it relates to the Medicare and Medicaid encounter and All Payer Claims Database business processes. Liaison Laurie Burckhardt (Appointed) Penny Probst - Secretary Meetings Standing Meetings: Interim Meetings: Joint Projects None Not Meeting at June 2017 Standing Meeting 1 st & 3 rd Friday s of each month, 9:30 10:30 EST 2017 X12 75

154 POST ADJUDICATED CLAIMS DATA REPORTING (PACDR) ASCX12N/SAC Major Activities Working on development of PACDR Member Reporting Guide Due to 7030 work, the PACDR SAC hasn t been able to move forward with our 7030 work. This is expected to change for the second half of X12 76

155 INTERNATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT BOARDS & COMMISSIONS (IAIABC) Overview The purpose of the International Association of Industrial Accident Boards & Commissions (IAIABC) is to advance the efficiency and effectiveness of workers' compensation systems throughout the world. The IAIABC is a not-for-profit trade association representing government agencies charged with the administration of workers' compensation systems throughout the United States, Canada, and other nations and territories. Liaison Sherry Wilson (Appointed) Meetings Occurred: Spring Forum was in Kansas City, MO, April 24 27, 2017 Upcoming: Bi-monthly calls next July 12th; Annual Convention will be in Portland, OR, Oct. 2 5, 2017 Joint Projects None 2017 X12 77

156 INTERNATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT BOARDS & COMMISSIONS (IAIABC) Major Activities Tennessee : Working on EDI rules/implementation date 1/1/2018 for payers and tentatively 7/1/2018 for providers. Project to collect and manage state proprietary procedure codes (277CA, 835, 837) Updating companion guide and model rule template. State Mandated Attachment Regulation Initiatives States adopted in 2005 HIPAA proposed attachment regulations (Ack and 275) 12 years later states/waiting for attachment regulations Close MN will adopt Federal Attachment Regulations (275/6020) States on short hold - anticipating federal regs Stakeholder concerns - conflict between state and federal regs Advocating current version to meets the stakeholder business needs vs Review - Implementation Guides Significant impact to industry, mitigates the need for 50 state EDI Companion Guides. Major IAIABC and X12 joint achievement working across states for EDI collaboration Resource for Summary of State EDI Regulations for Worker s Compensation and Auto: (ebill) 2017 X12 78

157 WORKGROUP FOR ELECTRONIC DATA INTERCHANGE (WEDI) Overview The purpose of WEDI is to provide multi-stakeholder leadership and guidance to the healthcare industry on how to use and leverage the industry's collective technology, knowledge, expertise and information resources to improve the administrative efficiency, quality and cost effectiveness of healthcare information. Liaison Stacey Barber (Appointed) Meetings Occurred: January 31, Impact MACRA: Essential Strategies in Economic Reform WEBINAR February 14, Telehealth in the Spotlight: One state s comparison of billing and reimbursement regulations - WEBINAR March 1, st Century Cures Act Overview WEBINAR May 15 18, 2017 WEDI 2017 Los Angeles, CA Upcoming: August 1-2, Summer Forum Prior Authorization: Review, Realign, Reform, ADA Conference Center, Chicago, IL Meeting information available at wedi.org Joint Projects Attachments Collaboration Project (ACP) 2017 X12 79

158 WORKGROUP FOR ELECTRONIC DATA INTERCHANGE (WEDI) Major Activities WEDI Council On Prior Authorizations formed to address issues and burdens associated with Prior Authorizations. X12 invited to sit on the council X12 80

159 2017 X12 81

160 WEDNESDAY, JUNE 7, 2017, 8:30 AM ITEM AND PROPOSE Call Meeting to Order Announcements Certificates of Appreciation Logistics (Changes and Additions) TGAWG1 info forum Cancelled Voting Items TGB/WG15 TR3 274 Project Proposal TGB/WG2 Purpose & Scope TGB/WG5 Purpose & Scope Discussion Items Adjourn PERSON Stacey Barber Stacey Barber Stacey Barber Stacey Barber Gail Kocher Stacey Barber Doreen Espinoza Gloria Davis Gloria Davis Stacey Barber 2017 X12 82

161 2017 X12 83

162 2017 X12 84

163 2017 X12 85

164 THURSDAY, JUNE 8, 2017, 1:15 PM ITEM AND PROPOSE Call Meeting to Order Announcements PERSON Stacey Barber Stacey Barber Logistics (Changes and Additions) Voting Items Stacey Barber Stacey Barber Discussion Items Report Outs Adjourn Stacey Barber Stacey Barber 2017 X12 86

165 REPORT OUT ORGANIZATION Technical Assessment Subcommittee X12J (TAS) Task Group A Program Management TGA WG and Liaison Report-Ins Task Group B Business TGB WG and Liaison Report-Ins Task Group C Technical TGC WG and Liaison Report-Ins X12C Liaison X12F Liaison X12M Liaison PACDR SAC SAD SAC REPRESENTATIVE(S) LuAnn Hetherington Becky Kimmick Debbi Meisner Deb Strickland Laurie Burckhardt Renee Juhn Gloria Davis Pete Anderson Web Mayfield Deborah Brown Debra Strickland Merri-Lee Stine Laurie Burckhardt Pete Anderson LuAnn Hetherington 2017 X12 87

166 TECH NICAL ASSESSMENT SUBCOMMITTEE (TAS) X12J Overview Maintains the X12.3 Data Element Dictionary, X12.22 Segment Directory, and X12 Design Rules and Guidelines. Processes, controls and coordinates requests for changes to the X12 EDI and XML standards and ensures that X12-approved design rules, guidelines and syntax rules are adhered to during the development and maintenance processes. Liaison LuAnn Hetherington, Primary (Appointed) Becky Kimmick, Alternate (Appointed) Meetings Standing Meetings: San Antonio June 5-7, 3:00-5:00 CT and June 12 3:00-5:00 ET Interim Meetings: Interim meeting held April 3-4, Next interim meeting August X12 88

167 TECH NICAL ASSESSMENT SUBCOMMITTEE (TAS) X12J Major Activities TR3 development moving from 6020 to 7030: Health Care Provider Information Health Care Provider Directory PACDR Professional PACDR Institutional PACDR Dental Data Maintenance Approved by X12N: X12C updates to X X12C Modify the BNF for data type ID X12N Standardize CMS naming to match code sources X12C Guideline pertaining to XML X12N Changing DE 554 to max 9 All documentation for this standing meeting is located on the X12N imeet space under the TAS June 2017 folder. A final copy be added to the documentation next week. Please see the TAS rep for any items that need to go to TAS, questions pertaining to items at TAS or any other questions about TAS X12 89

168 PROGRAM MANAGEMENT TASK GROUP X12N/TGA Overview This group is responsible for: Overseeing the collection, prioritization and workflow management of change requests. Co-Chairs Debbi Meisner (February 2018) Deb Strickland (February 2018) Secretary Kelly Butler Task Group Elections There were no Task Group Co-Chair elections X12 90

169 PROGRAM MANAGEMENT TASK GROUP X12N/TGA Major Activities None X12 91

170 PROGRAM MANAGEMENT TASK GROUP X12N/TGA Work Group Co-Chairs Term End Date Scheduled Elections 1 Regulatory Advisory/Collaboration Annette Gabel Gail Kocher 2 Change Management Kelly Butler Penny Probst 3 Documentation Management Deb McCachern Open Position 4 Procedural Review and Education Deborah Brown Penny Probst Oct 2017 Oct 2018 Oct 2018 Oct 2017 Jan 2019 Jan 2018 Jun election in Jun (open position) 2017 X12 92

171 REGULATION ADVISORY/COLLABORATION X12N/TGA/WG1 Overview This group is responsible for: Writing and executing the policies, procedures, and processes necessary to keep X12's Insurance Subcommittee (X12N) synchronized with insurance activities: e.g., relations with other Designated Standards Maintenance Organizations (DSMO) DSMO change request processing NPRM technical comment questions and responses Regulatory compliance Co-Chairs Annette Gabel (October 2017) Gail Kocher (October 2018) Secretary Open Position Elections There will be a co-chair election at the Fall meeting for Annette s position X12 93

172 REGULATION ADVISORY/COLLABORATION X12N/TGA/WG1 Informational Forums Canceled Cross Group Activities None. Meetings Standing Meetings: Pittsburgh, Sept , 2017 Interim Meetings: Third Wednesday every month, 4-5 PM Eastern Time Major Activities None. Did not meet as there were no agenda items to address X12 94

173 CHANGE MANAGEMENT X12N/TGA/WG2 Overview This group is responsible for: Reviewing, evaluating and prioritizing Change Requests submitted to X12 affecting existing and new X12N Technical Reports. Co-Chairs Kelly Butler (October 2018) Penny Probst (October 2017) Secretary Open Position Elections There will be a co-chair election at the Fall meeting for Penny s position X12 95

174 CHANGE MANAGEMENT 12N/TGA/WG2 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: This work group did not meet during the June Standing Meeting Interim Meetings: Every Wednesday 11:00 12:00 Eastern Time Major Activities none 2017 X12 96

175 DOCUMENTATION MANAGEMENT X12N/TGA/WG3 Overview This group is responsible for: All documentation pertaining to policies and procedures for the X12N Subcommittee and its Task Groups and Work Groups including but not limited to X12N Standing Documents, Policy and Procedure Documents and Training Materials. Co-Chairs Deb McCachern (January 2019) Nancy Senato (June 2019) Secretary Penny Probst (acting) Elections Nancy Senato elected as co-chair June 6, X12 97

176 DOCUMENTATION MANAGEMENT X12N/TGA/WG3 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Interim Meetings: Second Wednesday of the month, 3-4 PM Eastern Major Activities Elected Nancy Senato as co-chair. Discussed how to handle document change request when a group other than the document owning group requests a change. TGA/WG3 will handle notifying and getting permission for the change from the owning group. Documentation Workflow document will be updated X12 98

177 PROCEDURAL REVIEW AND EDUCATION ASC X12N/TGA/WG4 Overview This group is responsible for: Establishing the guidelines and for ensuring procedures were followed for all work products developed in ASC X12N; creating and maintaining training materials; and developing the educational programs for ASC X12N. Co-Chairs Deborah Brown (January 2018) Penny Probst (June 2018) Secretary ***WE NEED YOU*** Elections None X12 99

178 PROCEDURAL REVIEW AND EDUCATION ASC X12N/TGA/WG4 Informational Forums Wednesday, 06/07/17, 2:00 3:00 PM CT: 820, Payroll Deducted and Other Group Premium Payment for Insurance Products (007030X334) and the 820, Health Insurance Exchange Related Payment (007030X345) Cross Group Activities None. Meetings Standing Meetings: Monday and Wednesday, 3:00 5:00 PM CT each day; Tuesday 3:00 4:00 PM CT Interim Meetings: 1 st and 3 rd Thursday of each month, 10:00 11:00 AM ET Major Activities Approved the Informational Forum Process document Completed review and revision the TRC Checklist and Technical Report Approval Checklist (TRAC) 2017 X12 100

179 BUSINESS TASK GROUP X12N/TGB Overview This group is responsible for: This group oversees the work of multiple workgroups in developing business requirements pertaining to industry request for change or new development. TGB assures coordination among the workgroups under TGB a well as the X12N Technical Group (TGC) including, but not limited to, technical reports and data standards. Co-Chairs Laurie Burckhardt (October 2018) Gloria Davis (January 2018) Secretary Tina Greene Task Group Elections None for Summer Standing Meeting Election for Fall Standing Meeting 2017 X12 101

180 BUSINESS TASK GROUP X12N/TGB Major Activities WG2 and WG5 Purpose and Scope voted and approved 10 elections were held Work groups continue their progress on Informational Forums were held 2017 X12 102

181 BUSINESS TASK GROUP X12N/TGB Work Group Co-Chairs Term End Date Scheduled Elections 1 Benefit Donna Campbell Agnes Dorio 2 Billing, Encounter, & Claim Attachment James Mosteller Lynn Chapple Vacated Vacated 3 Payment Pamela Grosze Pat Wijtyk Heather Morgan 4 Invoice and Premium Payment Dora Lambert Open Position Jun 2019 Jun 2018 Jun 2019 Jan 2019 Jun 2019 Jun 2019 Jan 2018 Oct 2018 Jun elections in Oct elections in Oct Claim Status & Claim Acknowledgments Karen Shutt (convener) Mark Rabuffo (convener) 6 Entity Gail Kocher Debbi Meisner 7 P&C Policy Administration Kellie White Sue Mackenzie Open Oct 2018 Jun 2018 Jun 2018 Jan elections in Oct 2017, will consider staggering Cont X12 103

182 BUSINESS TASK GROUP X12N/TGB Work Group Co-Chairs Term End Date Scheduled Elections 8 Automobile Subrogation Not Active No elections 10 Services Review Bruce Bellefeuille Diane Franks Open Position 15 Provider Doreen Espinoza Lisa Savicki Tom Mort 16 Enrollment Gail Kocher Tina Martinez Jun 2019 Jan 2019 Jun 2018 Jun 2019 Oct 2017 Jan 2019 Jun X12 104

183 BUSINESS LIAISONS X12N/TGB Organization Dental Content Committee (DeCC) National Dental EDI Council (NDEDIC) Health Level 7 International (HL7) National Council for Prescription Drug Programs (NCPDP) Designated Standards Maintenance Organizations (DSMO) National Uniform Billing Committee (NUBC) National Uniform Claim Committee (NUCC) Insurance Industry Committee on Motor Vehicle Administration (ICMVA) Liaison Tom Mort Connor Carragher Tim McNeil Mary Lynam Stacey Barber, Primary Laurie Burckhardt,, Alternate Gail Kocher, Observer Laurie Burckhardt, Primary Debbi Meisner, Alternate Open, Technical Advisor Laurie Burckhardt, Primary Debbi Meisner, Alternate Open, Technical Advisor Angela Miller 2017 X12 105

184 BENEFIT INFORMATION X12N/TGB/WG1 Overview This group is responsible for: Creating, reviewing and maintaining (if applicable) business requirements that result from industry submitted change requests in addition to other X12N or X12N/TGB harmonization efforts as it relates to the eligibility and benefit information exchanged by or between any of the following: providers, clearinghouses, vendors and/or payers. Co-Chairs Aggie Dorio (June 2018) Donna Campbell (June 2019) Secretary Diane Rude (interim meetings only) Peggy Billhartz (standing meetings only) Elections Co-chair election, Donna Campbell re-elected, 2-year term 2017 X12 106

185 BENEFIT INFORMATION X12N/TGB/WG1 Informational Forums None. Cross Group Activities None Meetings Interim Meetings: Mondays, 2-4 PM Central, weekly on Tuesdays 3-4 PM Central. Friday AM Central. WG1 Collaboration Workspace has dial-in information Major Activities WG1 conducted a review of the X332 draft and reviewed updates via OnlyConnect. WG1 documented possible comments for Public Comment Updated BRTS 1576, X12 107

186 BILLING/ENCOUNTER & CLAIMS ATTACHMENT INFORMATION X12N/TGB/WG2 Overview This group is responsible for: Developing and managing the business requirements for claims, encounters, and claim attachment functionality (including but not limited to Health Care, Workers Compensation, Property and Casualty and Data Reporting). Co-Chairs Open (June 2019) - OPEN Jamie Mosteller (June 2019) Lynn Chapple (January 2019) Open Position (TBD) Secretary Katie Sullivan Elections Jamie & Chris were reelected Chris is resigning from his postion Nominations are now open for his position In addition the workgroup has voted to add a 4 th Co-chair position 2017 X12 108

187 BILLING AND ENCOUNTER INFORMATION X12N/TGB/WG2 Informational Forums None. Cross Group Activities STC12 meeting with TGB/WG5 Meetings Standing Meetings: Interim Meetings: While we have 7030 comments - Every Thursday 1:00 2:30 EST After 7030 comments - 2nd and 4th Thursdays 1:00 2:30 EST Major Activities 7030 comments 2017 X12 109

188 PAYMENT INFORMATION X12N/TGB/WG3 Overview This group is responsible for: Developing and managing business requirements for electronic data interchange standards related to the business of health care claim payment and payment verification. Co-Chairs Pam Grosze (June 2019) Pat Wijtyk (January 2018) Heather Morgan (October 2018) Secretary Open Elections Pam Grosze we reelected for 2 year term, ending June X12 110

189 PAYMENT INFORMATION X12N/TGB/WG3 Informational Forums None. Cross Group Activities Meetings Standing Meetings: Meet daily Interim Meetings: Every Wednesday and Mondays at 2:00 CT / 3:00 ET Major Activities Public Comment Responses reviewed 837 COB Public Comment Responses reviewed CARC/RARC Tuesday morning RFI 2214 reviewed 2017 X12 111

190 INVOICE AND PREMIUM PAYMENT INFORMATION X12N/TGB/WG4 Overview This group is responsible for: Bringing together Insurance industry representatives that will examine, develop, and maintain business requirements related to electronic data interchange standards of the Premium Payment transaction. Co-Chairs Dora Lambert (June 2019) Open Position Secretary Open Position Elections Election held, Dora re-elected as co-chair X12 112

191 INVOICE AND PREMIUM PAYMENT INFORMATION X12N/TGB/WG4 Informational Forums 820 Info Forum held on Wednesday. Cross Group Activities None. Meetings Standing Meetings: Pittsburgh, PA Interim Meetings: Second and Fourth Wednesdays, 2:00 PM ET Major Activities Reviewed open CRs Opted out of one, completed business requirements for another Reviewed draft technical solution for HIX CR Restructure changes Discussed scenarios for transaction examples Prepared for and held Info Forum 2017 X12 113

192 CLAIM STATUS AND CLAIM ACKNOWLEDGMENT ASC X12N/TGB/WG5 Overview This group is responsible for: Developing and managing the business requirements for claim status and claim acknowledgment functionality (including but not limited to Health Care, Workers Compensation, Property and Casualty). Co-Chairs Conveners: Karen Shutt Mark Rabuffo Secretary Cindy Monarch Elections September positions 2017 X12 114

193 CLAIM STATUS AND CLAIM ACKNOWLEDGMENT ASC X12N/TGB/WG5 Informational Forums None Cross Group Activities Meet with WG2 1:00) to hopefully finalize 7030 public comment on use of 277CA STC12 (Free form text element) Meetings Standing Meetings: M (9:30 5), T (8:30 5), W (9 5) Th. (8:30 11) Interim Meetings: TBD moving forward but have been meeting Tuesdays: 1:00 2:30 EST Major Activities 7030 Public Comment Adjudication 2017 X12 115

194 ENTITY INFORMATION X12N/TGB/WG6 Overview This group is responsible for: Identifying, documenting and maintaining business requirements used in the development, management and maintenance of information pertaining to entities (individuals and organizations) in the Standards and Technical Reports throughout all X12N transactions. Co-Chairs Gail Kocher, (October 2018) Debbi Meisner (June 2018) Secretary Open Position Elections Gail Kocher and Debbi Meisner were elected as co-chairs 2017 X12 116

195 ENTITY INFORMATION X12N/TGB/WG6 Informational Forums None. Cross Group Activities Worked with WG2 and WG3 on public comment responses for entity WG segment responsibility. Meetings Standing Meetings: Pittsburgh, Sept , 2017 Interim Meetings: Bi-weekly or as needed, day/time TBD - Major Activities Co-chair Elections Developed responses to comments received around HPID for the 835 and 837. Developed Responses for entity information not around HPID for the 835 and X12 117

196 P&C POLICY ADMINISTRATION X12N/TGB/WG7 Overview This group is responsible for: Developing, managing, and maintaining the business requirements for insurance information exchanged between insurance companies and interested parties including third-party aggregates, state entities, and mortgage and automobile lenders. Co-Chairs Kellie White (June 2018) Sue Mackenzie (January 2019) Open position Secretary Ann Chittatil Elections Co-chair open position 2017 X12 118

197 P&C POLICY ADMINISTRATION X12N/TGB/WG7 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: Pittsburgh, September Interim Meetings: TBD Major Activities CR1571 Create a new TR3 on Auto Insurance Notifications CR1340 Review of TR3 draft on SR Filings 811/820 review for Commercial/Business Insurance CR1464 Insurance carrier and lender/tracker request and response Reviewed Situational Rules in the Mortgagee Record Change Notification (266/824) IICMVA and State Reporting Update was provided 2017 X12 119

198 SERVICE REVIEW INFORMATION X12N/TGB/WG10 Overview This group is responsible for: Receiving and analyzing requests for new business functionality Developing the business requirements related to healthcare services utilization review events for referrals, authorizations, pre-certifications and notifications including the request and receiving of additional information to support the utilization review process. Co-Chairs Bruce Bellefeuille (June 2019) Diane Franks (January 2019) Open Position Secretary Theresa Doris Elections 1 Co-Chair position available for Sept 2017 Meeting 2017 X12 120

199 SERVICE REVIEW INFORMATION X12N/TGB/WG10 Informational Forums None Cross Group Activities None Meetings Standing Meetings: Mon (930-5), Tue (8-5), Weds (9-5), Thurs (9-12) Interim Meetings: Every Friday beginning June 16, 2017 (1:00-3:00 EST) Major Activities Continued with Change Log clean up Completed strategy to divide up work for x3 278 page turning excercises 2017 X12 121

200 PROVIDER INFORMATION X12N/TGB/WG15 Overview This group is responsible for: The development and maintenance of business requirements for the creation and maintenance of data standards for provider information. Co-Chairs Doreen Espinoza (June 2018) Lisa Savicki (June 2019) Tom Mort (October 2017) Secretary Open Position Elections Election held and Lisa was voted in as a new co-chair X12 122

201 PROVIDER INFORMATION X12N/TGB/WG15 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: September in Pittsburg Interim Meetings: First and Third Monday of each month 1:00pm EST Major Activities Worked on Calling Topics for 838 Provider EDI Enrollment Moved the 274 Provider Directory to next steps Held election 2017 X12 123

202 ENROLLMENT INFORMATION X12N/TGB/WG16 Overview This group is responsible for: Creating, reviewing and maintaining business requirements that are related to the business of insurance products enrollment and maintenance. Co-Chairs Gail Kocher (January 2019) Tina Martinez (June 2019) Secretary Open Position Elections None 2017 X12 124

203 ENROLLMENT INFORMATION X12N/TGB/WG16 Informational Forums None. Cross Group Activities Met with TG C WG 5 to discuss the definitions posted in the front matter of the 834 Guides. Meetings Standing Meetings: Next Meeting Pittsburgh Interim Meetings: 2nd Friday of every Month 11AM 12PM EST Major Activities Finished BRTS for CR 1681, CR 1682, and CR 1684 Posted for Vote on our WG space 2017 X12 125

204 TECHNICAL TASK GROUP X12N/TGC Overview This group is responsible for: The development and maintenance of work products including, but not limited to, technical reports and data standards. Co-Chairs Pete Anderson (June 2018) Web Mayfield (June 2019) Secretary Gloria Davis Task Group Elections This meeting: Web Mayfield elected to two-year term Next meeting: None 2017 X12 126

205 TECHNICAL TASK GROUP X12N/TGC Major Activities Considered updates to Technical Solution Principles Version transitions 2017 X12 127

206 TECHNICAL TASK GROUP ASC X12N/TGC Work Group Co-Chairs Summer Elections TGC Pete Anderson (6/18) Web Mayfield (6/19) 2 RFI Martin Wilbanks (1/18) Mark Carter (1/19) 3 Solution Development Cindy Fiore (6/18) Kelly Butler (6/19) 4 Technical Design Tim Pearson (10/17) Open (10/18) Web Mayfield elected co-chair None Kelly Butler elected co-chair Seeking nominees None None None Fall Elections 1 co-chair (10/18) 1 co-chair (10/19) 5 Harmonization LuAnn Hetherington (10/17) Pat Wijtyk (1/18) 7 EDI Acknowledgments Deborah Brown (6/19) Jerry Sobotka (1/18) None 1 co-chair (10/19) Deborah Brown elected co-chair None 2017 X12 128

207 REQUEST FOR INTERPRETATION (RFI) ASC12N/TGC/WG2 Overview This group is responsible for: Responding to Requests for Interpretation (RFI) assigned to ASC X12N by the ASC X12 Portal Screener. Coordinating with other ASC X12N Groups as necessary to respond to RFIs assigned to ASC X12N. Coordinating with other ASC X12 subcommittees when ASC X12N has interest in an RFI assigned to another sub-committee or when another subcommittee expresses interest in an RFI assigned to ASC X12N. Co-Chairs Mark Carter (January 2019) Martin Wilbanks (January 2018) Secretary Kim Peters Elections No elections 2017 X12 129

208 REQUEST FOR INTERPRETATION (RFI) ASC12N/TGC/WG2 Informational Forums None. Cross Group Activities None at this meeting Meetings Standing Meetings: Interim Meetings: All work is via online collaboration tool and Major Activities Gathered workgroup input on 4 RFIs, (2196, 2199, 2214, 2217) RFI status 2 Assigned 3 C Primary 5 - Submitted for workgroup review/vote 3 - Approved by management 2017 X12 130

209 SOLUTION DEVELOPMENT X12N/TGC/WG3 Overview This group is responsible for: Identifying, and documenting technical solutions for all X12N work group change requests. Coordinating with X12N business work groups on all change requests. Entering technical solutions into OnlyConnect. Coordinating with the Technical Design work group (WG4) when DM/CMR may be required to complete a change request. Co-Chairs Cindy Fiore (June 2018) Kelly Butler (June 2019) Secretary Cindy Fiore (Acting) Elections Kelly Butler was elected Co-Chair by unanimous consent, term end-date 6/ X12 131

210 SOLUTION DEVELOPMENT X12N/TGC/WG3 Informational Forums None. Cross Group Activities Meeting with TGC WG4 to review outstanding change requests that require DM/CMR. Meetings Standing Meetings: Tuesday 6/6 joint meeting with TGC WG4 Tuesday 6/6 10:00am 10:15 Co-Chair Vote Wednesday Cancelled Session Interim Meetings: 1 st and 3 rd Tuesday of each month, 3 p.m. Eastern Time Major Activities None X12 132

211 TECHNICAL DESIGN X12N/TGC/WG4 Overview This group is responsible for: The group is responsible for the design, development and maintenance of work products including, but not limited to data standards. Co-Chairs Tim Pearson (October 2017) Open (October 2018) Secretary None; Tim Pearson (Acting during Standing Meetings) Elections Tim Pearson co-chair election in October, Becky s position still open X12 133

212 TECHNICAL DESIGN X12N/TGC/WG4 Informational Forums None. Cross Group Activities Joint Session with TGC/WG3 Meetings Standing Meetings: September in Pittsburg, PA (same schedule as this week) Interim Meetings: None scheduled at this time. Please contact Becky or Tim if you have the need to meet and we will schedule it. Major Activities Approved DM and sent to N Management Approved DM and sent to N Management Deferred DM Notified TAS Rep 2017 X12 134

213 HARMONIZATION X12N/TGC/WG5 Overview This group is responsible for: Ensuring the efficient exchange of business information for insurance including, but not limited to, Health Care and Property & Casualty. Ensuring compliance with X12 standards, design rules, and guidelines. Satisfying the functional business requirements established by other X12N Task Groups. Coordinating with the X12N liaisons where assigned and with other X12 Subcommittees, if applicable. Co-Chairs LuAnn Hetherington (October 2017) Pat Wijtyk (January 2018) Secretary Open Position Elections Nominations are open for LuAnn s position in October 2017 X12 135

214 HARMONIZATION X12N/TGC/WG5 Informational Forums None. Cross Group Activities Public Comment Cycle 1 work groups to review terms and definitions Meetings Standing Meetings: Monday 2:00 3:00 and Wednesday 2:00-3:00 Interim Meetings: Tuesdays 11:00 12:00 ET Major Activities Common Content Terms and Definitions Public Comment Responses 2017 X12 136

215 EDI ACKNOWLEDGMENTS X12N/TGC/WG7 Overview This group is responsible for: Developing and maintaining electronic data interchange standards related to the business of insurance transaction acknowledgments. Co-Chairs Deborah Brown (June 2019) Jerry Sobotka (January 2018) Secretary Jerry Sobotka (Acting) Elections Co-Chair Deborah Brown re-elected to a 2 year term ending June X12 137

216 EDI ACKNOWLEDGMENTS X12N/TGC/WG7 Informational Forums None. Cross Group Activities None. Meetings Standing Meetings: September 2017 Pittsburgh, PA Interim Meetings: Tuesdays 2:00 pm to 3:30 pm eastern. Major Activities Review of Public Comments for X335 (999) Discussion of Public Comments and opportunities to improve CTX Business Unit Identification segment Focusing on completing responses to Public Comments such that Informational Forum can be held in September X12 138

217 COMMUNICATIONS AND CONTROLS SUBCOMMITTEE X12C Overview Focuses on interchange and application control structures, control and management transaction sets, EDI architecture, data security, service specifications and other technical issues associated as they relate to the standards and their processes Develops X12's XML Reference Model and design rules Provides technical liaison on behalf of X12 with national and international organizations involved in related activities. Liaison Deborah Brown (Appointed) Meetings Occurred: Upcoming: Joint Projects None 2017 X12 139

218 COMMUNICATIONS AND CONTROLS SUBCOMMITTEE X12C Major Activities None X12 140

219 FINANCE SUBCOMMITTEE X12F Overview Develops and maintains X12 EDI and XML standards including technical guidelines focusing on financial e-business models Develops and maintains financial business models related to areas such as credit card processes, financial remittance delivery, invoice, and payment transactions. Real estate and mortgage lending messages are also developed and maintained using EDI and XML standards. Develops payment systems architecture to include data security and data content management for financial standards Liaison Deb Strickland (Appointed) Meetings Occurred: Upcoming: Joint Projects None 2017 X12 141

220 FINANCE SUBCOMMITTEE X12F Major Activities None X12 142

221 SUPPLY CH AIN SUBCOMMITTEE X12M Overview The Supply Chain Subcommittee designs, develops and maintains standards for existing and new business requirements relating to supply chain excluding transportation and finance. It actively pursues integration and coordination with other areas including, but not limited to finance, transportation and insurance (property and casualty; life and annuity; healthcare), or any other functional areas. Liaison Merri-Lee Stine (Appointed) Meetings Occurred: Upcoming: Joint Projects None 2017 X12 143

222 SUPPLY CH AIN SUBCOMMITTEE X12M Major Activities None X12 144

223 POST ADJUDICATED CLAIMS DATA REPORTING (PACDR) X12N/SAC Overview The purpose of the Post Adjudicated Claim Data Reporting (PACDR) Special Appointed Committee is to facilitate an expedited development of implementation guides intended to standardize the process of exchanging PACDR related data as it relates to the Medicare and Medicaid encounter and All Payer Claims Database business processes. Liaison Laurie Burckhardt (Appointed) Meetings Standing Meetings: Did not meet during the June Standing Meeting Interim Meetings: TBD Joint Projects None 2017 X12 145

224 POST ADJUDICATED CLAIMS DATA REPORTING (PACDR) ASCX12N/SAC Major Activities None X12 146

225 SOLUTIONS APPROVAL DEVELOPMENT (SAD) X12N/SAC Overview The purpose of the Solutions Approval Development Special Appointed Committee (SAC) is to establish a new process for membership approval of Business Requirements and Technical Solutions. Liaison Pete Anderson, Convener (Appointed) LuAnn Hetherington, Convener (Appointed) Meetings Standing Meetings: Interim Meetings: Joint Projects None 2017 X12 147

226 SOLUTIONS APPROVAL DEVELOPMENT (SAD) X12N/SAC Major Activities None X12 148

227 THANK YOU FOR ATTENDING Thank You X Greensboro Drive, Suite 800 McLean VA (703) store.x12.org 2017 X12 149

228 2017 X12 150