HL7, ASC X12 push to develop claims attachment standards again

Standards development organizations Health Level Seven and the Accredited Standards Committee X12 (ASC X12) have asked the National Committee on Vital Health Statistics (NCVHS) to be designated as the entities to develop standards for electronic document attachments, Health Data Management reports.

These are the same organizations that created an electronic claim attachments standard that the Department of Health & Human Services proposed in 2005. While that standard was never implemented, it was required under HIPAA.

Health plans have been slow to embrace standardized transactions, in general. Long after the 4010 transaction set was promulgated, for instance, the insurers continued to publish "companion guides" that specified how claims and claims-related transactions were to be sent to them.

To overcome this barrier, the Affordable Care Act requires the Centers for Medicare & Medicaid Services (CMS) to use the operating rules developed by the Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE), a group of industry stakeholders.

In an interim final rule published last summer, CMS adopted the CORE rules for insurance eligibility and claims status. Last February, NCVHS, a government advisory body, recommended that CORE create operating rules for non-retail pharmacy transactions.

CORE has not gotten around to claims attachments yet. So whether the new HL7 and ASC X12 specs will fare any better this time around is unknown.

Ironically, CMS is moving forward with the Electronic Submission of Medical Documentation (esMD) program to enable providers to send documents electronically to government auditors. Phase 1 of the program began Sept. 15. 

To learn more:
- read the Health Data Management article
- see the original document attachments proposal from 2005 (.pdf)
- check out the esMD page on CMS' website 


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