# Presentation: 405129

## POC Project Team Participants

**Anthem**
**Gale Carter**
**Conny Nichols**
**Empire Blue Cross Blue Shield**
**Christine Stahlecker**
**Joanne Weingarth**
**Health Care Service Corporation**
**Durwin Day**
**Maria Ward**
**Highmark, Xact Medicare Services**
**Julie Meehan**
**Mary Lynn Bushman**
**United Health Care Corporation**
**Michael Cabral**
**Gerry Czupryna**

## SDO Recommendation for Attachment Transaction

**X12N SDO management****	****	****	****April 1997**
**HL7 SDO management****	****	****	****April 1997**
**                 **_**Outreach**_
**Commercial Insurers****	****	****	****June 1997**
**X12N Commercial Caucus****	****	****	****August 1997**
**HL7 SDO Plenary Meeting****	****	****	****August 1997**
**National Uniform Claim Committee****	****	****September 1997**
**Medicaid State TAG****	****	****	****	****September 1997**
**X12N Blue Caucus****	****	****	****	****October 1997**
**National Uniform Billing Committee****	****	****November 1997**
**NCVHS****	****	****	****	****	****November 1997**
**WEDI****	****	****	****	****	****November 1997**
**Payer/Provider Attachment Mtg****	****	****November 1997**

**Notes:**
In April, 1997 X12N Management recommended the 275 Patient Information Transaction as the X12 transaction to use in order to transmit additional information from Provider to Payer. 
In addition, X12N management supported the inclusion of HL7 within the attachment transaction.

## POC Phase 1 - Attachment Types

**1. ****	****	****Ambulance**
**2a. ****	****Home Health Certification Form 485**
**2b. ****	****Home Health Certification Form 486**
**2c. ****	****Home Health Certification Late Lyme Disease**
**2d.****	****	****Home Health Certification BCBSIL**
**3a.****	****	****Outpatient Rehabilitation**
**3b.****	****	****Alcohol Substance Abuse**
**4.****	****	****Emergency Room Reports and Records**
**5.****	****	****Notes/Reports**
**6.****	****	****Referrals**
**7.****	****	****Explanation of Benefits**
**8.****	****	****Workers Comp**
**9.****	****	****Skilled Nursing Facility (SNF)**
**10.****	****	****Auto Liability**
**11.****	****	****End Stage Renal Disease (ESRD)**
**12. ****	****Plan of Treatment**
**13.****	****	****Invoice**
**14.****	****	****Letters**
**15.****	****	****Lab**
**16.****	****	****Pharmacy**
**17. ****	****Congenital Malformation Registry**
**18.****	****	****Alzheimer Registry**

## Phase 1 Attachment Selection Criteria

**Frequency - Currently in use (Efforts that created the list of attachments)**
**HCFA Survey (provider/payer)**
**NUCC Survey (provider/payer)**
**Letters sent to Commercial Insurers by POC Team**
**Review among POC/payers/providers)**
**Needs were identified to POC team by state agencies**

## Attachment POC Work in Progress

**Attachment Spreadsheets identifying each data element**
**Coding Methodology**
**Implementation Guide development**
**Creation of workgroup to standardize the questions asked by the payers to the providers**

**Notes:**
Explain the spreadsheets (first and the most recent for ambulance).
Current codified messaging structure being considered by POC is  Logical Observation Identifier Names and Codes (LOINC)

LOINC codes will be unique to the individual questions.  No repetitive use of questions.

Also there will be the potential for one LOINC per attachments set of data

Value of the LOINC code is the total automation from Provider/Payer side.

X12 Imp Guide
First X12 imp guide written that incorporates the HL7 standard.
Issues:
copyright
version release timing differences
Possible vocabulary semantic differences

Creation of workgroup
Payers ask different questions - need standardization
Workgroup started with first conference call on January 22, 1998 including 28 participants.  The next call is scheduled for February 17, 1998.  During that call the entire structure of the committee will be formalized.  

Outstanding issues on this committee
Who will control this group

## Attachment POC Work to be Done

**Testing Request and Attachments at provider & payer site**
**Identification and resolution of issues that arise during testing**
**Preparation of executive summary of findings and recommendations**
**Standardizing questions from payer to provider with larger workgroup**
**HIPAA Implementation team is chartered to write the NPRM by 8/98**
**National Center for Health Statistics will organize a committee to address public health needs**

**Notes:**
Testing
First transaction to be done that will have testing prior to the NPRM
Participating payer/provider locations