Draft versions of the following X12N version 005010 837 Health Care
Claim and Data Reporting Implementation Guides are now available for
public review and comment as a key step in their X12 Type 3 Technical
Report (TR3) publication process:
837 Health Care Claim - Professional - 005010X222
837 Health Care Claim - Institutional - 005010X223
837 Health Care Claim - Dental - 005010X224
837 Health Care Service Data Reporting - 005010X225.

The public comment period for each of these guides commenced on 26
January 2005 and will close on Saturday, 26 March 2005, at 2:00 pm
Eastern time.

The purpose of these 837 Implementation Guides is to, "provide a
definitive statement as to the data requirements trading partners must
support for the submission of Health Care claims and encounters." Each
Implementation Guide provides specific instruction applicable to the
line of business defined: Dental, Institutional, Professional, and
Data Reporting. Additionally,
· the Dental, Institutional, and Professional Implementation Guides
provide the specifications for claims, encounters, and Medicaid
subrogation,
· the Service Data Reporting Implementation Guide provides the
specifications for reporting health care services data. The health
care services data is critical information that measures utilization
rates, provides health data statistical analysis from provider data,
and satisfies governmental legislative mandates necessary to regulate
the health care industry.

This is X12's only unconstrained public comment period. The authors of
these guides will consider all comments during and following the public
comment period. For a complete understanding of changes being suggested
and/or made to these guides, reviewers should monitor the on-line
conferences during the public comment period and consider all author
responses prior to the corresponding Informational Forums. Official
authoring work group responses will be posted to the on-line conferences
at least 15 days prior to the corresponding Informational Forums.

An announcement of the corresponding Informational Forums will be made
later. The Informational Forums, held during an X12 Trimester Meeting,
probably the one during the first full week of June, 2005, [see
http://x12.org/x12org/meetings/x12trimt/index.cfm ], are the final X12
opportunity to comment: but only on modifications based on the received
public comments. After that, the guides are finalized for movement
through the Insurance Subcommittee (X12N) and X12 publication approval
processes.

The draft implementation guides are available for free download at:
http://www.wpc-edi.com/HealthCareDraft.asp . Comments on the drafts can
be submitted by anybody via the on-line conference at:
http://www.wpc-edi.com/conferences/healthcare.html .

___

SPECIAL NOTES ON COMMENT FORMATTING

The authoring work group expects to receive a large volume of comments
and is developing a database to manage comment processing. For this to
work effectively, comments need to be received in a consistent format.
Following the guidelines listed below will help ensure that the
authoring work group can provide a thorough and meaningful response to
each comment.

Business Case
It is important to include a thorough business case to support your
comment, especially if the comment pertains to data usage. The business
case is the basis for the authoring work group decision. If it is not
clear what benefit is achieved with the suggested change, the work group
may not be able to give the comment appropriate consideration.

Individual Comments
When posting one comment at a time to the conference thread, please
enter the information listed below into the Topic line exactly as it
relates to your comment. Moreover, each Topic line should be formatted
as follows.

1) The word "page" followed by a space and the page number followed
by another space. If the subject of your comment spans more
than one page, list the first page only. If your comment
applies to multiple iterations of the same subject, list the
first page only on the topic line and include a listing of
other occurrences in the text of your comment.
(e.g., also occurs on pages ...)

2) A) If your comment applies to a segment or a data element - The
word "Loop" followed by a space and the loop ID (e.g.,
2330B, 2300, 2010AB) followed by another space.
2) B) If your comment applies to Section 1 - The word "Section"
followed by a space and the section ID (e.g., 1.6.2,
1.4.3.4) followed by another space.
2) C) If your comment applies to an Appendix - The word "Appendix"
followed by a space.

3) A) If your comment applies to a segment or a data element - The
last piece of data should be the segment (e.g., N4, CLM,
HI) or the data element (N402, PER03)
3) B) If your comment applies to Section 1 - The last piece of data
should be the name of the section (e.g., 999
Implementation Acknowledgment)
3) C) If your comment applies to an Appendix - The last piece of
data should identify the text the comment is referencing.

Bulk Comments
Past history has demonstrated a desire for people to provide their
comments in either a Word document or Excel spreadsheet in favor of
posting multiple comments to the conference. The authoring work group
recognizes the efficiencies realized by using this method. However,
this method creates challenges in the review and response process. In
an attempt to make this a positive tool for both the commenter and the
work group, you are requested to use a table in Word or Excel with the
following columns if you wish to provide bulk comments.
Page
Loop ID
Segment
Requested Change
Business Case
Work Group Response
Tables organized in this manner are designed to include all of the
information needed for the work group to process your comments and
respond.
___


The Dental, Institutional, and Professional Claims 837 Implementation
Guides are newer versions, 005010, of the ones of the same titles
presently adopted under HIPAA, 004010 and 004010A1. The present plan is
to propose the finalized versions of these draft guides, modified based
on any public comments, as new HIPAA standards.

While the 837 Service Data Reporting Implementation Guide is also a new
version of a previous guide, it is not a counterpart of any that have
been adopted under HIPAA, and no official discussions regarding any such
adoption have been held. A factor in such discussions, should they be
initiated, will be any comments received. Voluntary use, once this
guide is published as a TR3, is, of course, permissible at any time
based on negotiated agreements between willing trading partners. HIPAA
is a floor, not a ceiling!

Participation in the public comment period for these four guides is open
to all who may be interested. Please participate -- this is the highest
leverage opportunity for anybody outside of the authors to impact these
documents.

Dave Feinberg
Co-chair, HIPAA Implementation Work Group
Insurance Subcommittee (X12N)
Accredited Standards Committee X12
Rensis Corporation [A Consulting Company]
206-617-1717
DAFeinberg@...