Product Claims Attachments

Product Brief - Claims Attachments

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Product Name

Claims Attachments

Standard Category

Health Information Exchange Standards

Integration Paradigm

Documents

Summary

In response to the federal mandate under HIPAA, HL7 and ASCX12 collaborated for a number of years to develop standards for claims attachments. This joint development effort has resulted in standards for attachments to healthcare claims, and pre-certification / pre-authorization transactions. HL7 attachments standards are based on the Clinical Document Architecture (CDA) and have been proposed by the Department of Health and Human Services (HHS) as the standard for claims attachments under HIPAA. In the HHS proposal, six attachment types developed by HL7 have been put forward for adoption: clinical reports; rehabilitation services; laboratory results; medications; ambulance services; and emergency department.

Description

After seeing the model for use with claims attachments, the X12 Work Group addressing Pre-certification and Pre-authorization decided that these standards would also benefit their transaction (X12N 278). As a result we now have ability to do attachments for the X12 278 also. The HL7 standards referenced above are used to convey clinical and other supporting information. The model moves information from provider to payer, either unsolicited (attachment is sent with claim, or 278 for example) or solicited (request is made by payer for the attachment – in our solution it’s made by an X12N 277 transaction). Even though this initiative started out only as development of claims attachments, many different attachment needs have been expressed to the HL7 committee in the recent past. As time permits, these requests will be addressed. So far we’ve seen two very successful pilots of the claims attachments standards (that we know of), both of which moved into production. One case study is below. The payer sharing their story in this case study discusses how the success of their early adoption led them to roll this solution out to all of their Medicare providers, ahead of any Medicare requirement to do so. The HL7 attachment standards are based on the Clinical Document Architecture (CDA) and have been proposed by the Department of Health and Human Services (HHS) as the standard for claims attachments under HIPAA (Health Insurance Portability and Accountability Act of 1996). In the HHS proposal, six attachment types developed by HL7 have been put forward for adoption: Clinical Reports; Rehabilitation Services; Laboratory Results; Medications; Ambulance Services; and Emergency Department (ED), but we expect that the ED will be rolled into the Clinical Reports.

Resources

Work Groups

• Attachments WG (aka ASIG)

Education

• See more at http://hl7new.amg-hq.net/implement/training.cfm

Certification Available

• none

Presentations

From HIMSS 2009

• HIMSS 2009 presentation on WPS case study