Group Minutes X12N TG2 WG5/WG9 Healthcare Claim Status/Patient Information February 2 5, 2004

Transcription

1 ASC X12N/TG2/WG5-WG9/ Group Minutes February 2 5, 2004 Chair(s) Name Company Term End Date Phone Mary Lynn Bushman (WG9) Empire Medicare Services June 2005 (717) Mary.Bushman@Empireblue. com Mike Cabral (WG5) Edifecs February 2004 (425) mikec@edifecs.com Gale Carter (WG9) FP Technologies June 2005 (317) gcarter@fptech.com Durwin Day (WG5) HCSC February 2004 (312) dayd@bcbsil.com Anthony Rizzi (WG9) Kaiser Permanente October 2004 (626) Anthony.j.rizzi@kp.org Secretary(s) Name Company Term End Date Phone Lynda Bowen (WG5) Unisys October 2006 (405) lynda.bowen@unisys.com Quorum Requirement Statement (please check one). This group enforces quorum requirements for group voting items.. This group does not enforce quorum requirements for group voting items. X Work Products and Status (e.g. Transaction Sets, Implementation Guides, UN/CEFACT development, etc.) Work Product ID # (if applicable) Work Product Name Work Product Status X Request for Additional Information (November 2003, Work in progress Draft 1) X Additional Information to support a Health Care Claim or Work in progress Encounter (November 2003, Draft 3) X Acknowledgement (Version 4040) Proof Status X /277 Claim Status Inquiry/Response (version 4050) Proof Status X Additional Information to Support a Health Care Service Draft Status Review (Version 4030) X Provider to Provider Draft Status

2 ASC X12N/TG2/WG5-WG9/ Group Minutes February 2 5, 2004 Chair(s) Name Company Term End Date Phone Mary Lynn Bushman (WG9) Empire Medicare Services June 2005 (717) Mary.Bushman@Empireblue. com Mike Cabral (WG5) Edifecs February 2004 (425) mikec@edifecs.com Gale Carter (WG9) FP Technologies June 2005 (317) gcarter@fptech.com Durwin Day (WG5) HCSC February 2004 (312) dayd@bcbsil.com Anthony Rizzi (WG9) Kaiser Permanente October 2004 (626) Anthony.j.rizzi@kp.org Secretary(s) Name Company Term End Date Phone Lynda Bowen (WG5) Unisys October 2006 (405) lynda.bowen@unisys.com Next Trimester Meeting Notification Date: June 2004 Location: Chicago, IL Contact Person: Agenda (include key items): Continue working jointly with WG5 & 9 Review the Proof copies of the X150 and X151 Implementation Guides Claims Attachment Education (LOINC codes, HL7, CDA, 277 and the 275) Begin work on the 5010 Implementation Guides. Elections Scheduled (include position and term dates): Co-chair elections Due to tie vote in February, 2004, elections will be held again in June. Nominations have been closed. There is one co-chair position open. Karen Shutt and Tapan Shah are the candidates. Special Meeting Notification (e.g. Interim Conference Calls, Industry Meetings, Regulatory Agency Meetings, etc.) Date: 2/17/04 5/25/04 Bi weekly Teleconference calls, Tuesdays for WG 5&9 2:30 to 4:00 Eastern Location: Teleconfernce Contact Person: WG9 Mary Lynn Bushman WG5 Mike Cabral Agenda: Continue to work on any action items from the February X12 meeting. Continue to work on the Implementation Guides

3 Executive Summary of Current Meeting (optional, but recommended): Date: February 2 5, 2004 Location: Seattle Agenda: Continue to work jointly with WG 5 & 9 Address responses to the X150 and X151 IG X12 public comment period Co-chair elections Durwin Day and Karen Shutt s terms expire in February. Informational Forum for the X150 and X151 guides Summary of Major Accomplishments: Addressed the X150 and X151 comments during the Informational Forum. The X150 and X151 IG s were voted to move forward with publication. Elections Held (include position, term dates, and individual s name): Durwin Day Co-chair February, 2004 to February, Karen Shutt s term also expired. There was a tie between two candidates (Karen Shutt and Tapan Shah). This election will be held at the June meeting. Date and Minutes of Current Meeting Date: Monday February 2, 2004 Location: Seattle A. Voting Items NONE B. Data Maintenance Items NONE C. Key Discussion Items Discussed the Informational Forum approach of discussing only the Disagree responses. It was explained by the co-chairs that the comments were grouped together by category. Discussed the comments that the work group response was listed as Disagree. We wanted to ensure the work group was okay with the discussion items for the Informational Forum. D. Informational Forum Notes 1. Forum Details X150, X151 Informational Forum to be held February 3, 2004 meeting a. Date/Time February 03, 2004 b. Title/Topic Informational Forum on the 277 Request for Additional Information, 275 Additional Information to support a Health Care Claim or Encounter guides. 2. Forum Notes - None E. Joint Meeting Notes 1. Meeting Details a. Date/Time b. Title/Topic c. Participants 2. Meeting Notes F. Other Notes

4 Date and Minutes of Current Meeting Date: Tuesday February 3, 2004 A. Voting Items A motion was made to defer adding modifiers to accommodate the payer s question justification to the HL7 ASIG work group. B. Data Maintenance Items NONE Yes 21 No 0 Abstain - 5 C. Key Discussion Items Continued with the discussion on the comments with the responses listed as Disagree. Based on the California law, there is a need for the 277 Request for Additional Information to include the payer s justification for asking the question. Dave Schinderle had a preliminary list of justification reasons which was developed with the California payers. There was some concern with using specific LOINC codes. Through the discussion the work group thought that the Modifiers (HL7 Specification Booklet) may be the best solution. This would require new Modifiers to be added to the list. This will need to be discussed at the next HL7 meeting. See the website to signup for the ASIG list serve Joanne Weingarth explained a concern with the X167 STC notes. The notes need to be clarified. This issue will be discussed further on Wednesday. Informational Forum was held. D. Informational Forum Notes 1. Forum Details X150, X151 Informational Forum to be held February 3, 2004 meeting a. Date/Time February 03, 2004/4:00 to 5:00 Pacific Time b. Title/Topic Informational Forum on the 277 Request for Additional Information, 275 Additional Information to support a Health Care Claim or Encounter guides. 2. Forum Notes All comments were categorized by the type of response. These lists will be added to the WPC comment threads. The comments that were categorized with Disagree responses were discussed. There were no comments. E. Joint Meeting Notes 1. Meeting Details a. Date/Time b. Title/Topic c. Participants 2. Meeting Notes F. Other Notes

5 Date and Minutes of Current Meeting Date: Wednesday February 3, 2004 A. Voting Items Durwin Day made a motion to approve the X150 and X151 guides. Sue Thompson seconded the motion. During the discussion the group wanted to know what the next steps were. Mike Cabral explained that we needed TG4 approval, as well as taking the vote to TG2 and X12N. If approved, Mike and Mary Lynn will then incorporate all comments grouped as Agree into the appropriate guides. Yes 23 No 0 Abstain 0 Co-chair elections were held for two open positions in WG 5, Durwin Day and Karen Shutt. The three candidates were Durwin Day, Tapan Shah and Karen Shutt. Alix Goss and Larry Watkins joined the workgroup to run the election. Durwin Day was re-elected. There was a tie between Tapan Shah and Karen Shutt. Penny Sanchez made a motion to close nominations. The motion was seconded by Mary Lynn Bushman. Yes 23 No 0 Abstain - 0 Gale Carter made a motion to hold the third co-chair election until the June X12 meeting. The motion was seconded by Chris Stahlecker. During the discussion Gale accepted a friendly amendment to defer the co-chair election until the June X12 meeting. Yes 21 No 1 Abstain 1 Gale Carter made a motion to accept the X167 STC note revisions as worded in the minutes. This motion was seconded by Bob Davis. Yes 22 No 1 Abstain - 1 B. Data Maintenance Items NONE C. Key Discussion Items Based on the tie for the second co-chair position, we discussed the following options: 1. Wait until the next meeting (June, 2004) and hold another vote 2. Flip a coin 3. Allow both Karen and Tapan to be co-chairs 4. Make both Tapan and Karen facilitators until the June X12 meeting The group decided to wait until the June X12 meeting to hold another vote. Tapan and Karen will have a chance to state their case for the co-chair position at the June meeting. The group discussed the issue with the STC notes in the X167 guide. The notes in question were on page 58, STC03 notes for the U and WQ qualifier, page 72 and 73, HL segment notes 1 and 2, and page 83, STC03 notes for the U and WQ qualifier. The notes for the U and WQ qualifier do not support the business need for a claim file received that includes multiple provider within a ST/SE where one of the

6 providers claims are rejected and another providers claims are accepted. The notes on page 58 will be revised as follows: STC03, qualifier U usage note will read Required when the entire transaction (ST/SE) is rejected at the submitter level. No subordinate HL information is reported. The WQ qualifier note will read Required when U is not used. At least one subordinate HL must be reported. Chris Stahlecker provided information from the WEDI SNIP group. Due to some payers stating that an analysis of current attachments being used should be reviewed, WEDI SNIP is putting together an Industry Survey. They would like to have a small group assist with this task. Anyone interested in participating in this group should contact one of the co-chairs. Robert Barbour from Montifori Hospital asked the group to consider adding the pay to address to the X They have a business need that is currently not met in the 277. They have an internal issue with the payment and payment information being routed to the incorrect department. They want to use the 276/277 to identify the pay to address in these situations. When the funds are misdirected if they have the post office box or address it would help them identify the department who erroneously received the payment. The payers were not sure that this information would be available in the claim status systems. Further research needs to be done. This will be discussed on the scheduled conference calls. TG4 approved the X150 and X151 guides contingent upon the TG2 vote. They also approved the rewording of the STC notes in the X167 guide. D. Informational Forum Notes 1. Forum Details X150, X151 Informational Forum to be held February 3, 2004 meeting a. Date/Time February 03, 2004/4:00 to 5:00 Pacific Time b. Title/Topic Informational Forum on the 277 Request for Additional Information, 275 Additional Information to support a Health Care Claim or Encounter guides. 2. Forum Notes E. Joint Meeting Notes 1. Meeting Details a. Date/Time b. Title/Topic c. Participants 2. Meeting Notes F. Other Notes Date and Minutes of Current Meeting Date: Thursday February 5, 2004 A. Voting Items B. Data Maintenance Items NONE C. Key Discussion Items

7 The group decided to schedule one joint WG 5 & 9 conference call on a bi-weekly basis. They also decided that the best time would be 2:30 to 4:00 Eastern time. Mike Cabral will schedule the calls for the following dates: 2/17, 3/2, 3/16, 3/30, 4/13,4/27, 5/11 and 5/25. The 5010 guides will be sent to the list serves The agenda for the June X12 meeting will include: Begin work on the 5010 guides Submit a project proposal for the 277 Pended Claim Claim Attachments Education Proof the X150 and X151 guides Return of the Provider Attachment Control Number in the 277 Durwin will include the X167 STC note changes in the X139 guides Mike explained the proposed IG publication schedule. This was discussed during the Tuesday night TG2 Management meeting. This schedule requires the WG s to produce a new version of each IG on a 2 year cycle. This will be discussed further on the Management calls. There was discussion on the Handbook requirements for the situational notes in the guides. The co-chairs stated that their understanding was that with the statement Do not send if the situation is not met means that if you do not meet the situation and you send the data the transaction would not be compliant. Work group 2, Claims, joined the group to discuss a few attachment questions. The claims co-chairs revealed a new scenario related to the exchange of data between the Provider community and the payer community. Providers are implementing attachment repository systems and assigning an attachment control number to this data. They wanted to explore the possibility of including the providers attachment control number in the 277 request. Currently we only send the payer control number in the 277 request. There was concern in the group that if the payer used the providers attachment number that the providers who send the attachment information based on the attachment control number and not based on the LOINC code asking the questions. This could lead to the payer not receiving the information needed to adjudicate the claim. Since more time is needed to discuss this topic no decision were made. This will be added as an agenda item for the June meeting. D. Informational Forum Notes 1. Forum Details X150, X151 Informational Forum to be held February 3, 2004 meeting a. Date/Time February 03, 2004/4:00 to 5:00 Pacific Time b. Title/Topic Informational Forum on the 277 Request for Additional Information, 275 Additional Information to support a Health Care Claim or Encounter guides. 2. Forum Notes All comments were categorized by the type of response. These lists will be added to the WPC comment threads. The comments that were categorized with Disagree responses were discussed. There were no comments. E. Joint Meeting Notes 1. Meeting Details a. Date/Time b. Title/Topic c. Participants 2. Meeting Notes

8 F. Other Notes Group Minutes