Draft versions of the following X12N version 005010 278 Health Care
Services Review Implementation Guides are now available for
public review and comment as a key step in their X12 Type 3 Technical
Report (TR3) publication process:
278 Health Care Services Review Request for Review and Response -
005010X217
278 Health Care Services Review Notification and Acknowledgement -
005010X216
278 Health Care Services Review Inquiry and Response -
005010X215.

The public comment period for each of these guides commenced on
16 May 2005 and will close on Sunday, 31 July 2005, at 5:00 pm
Eastern time.

The purposes of each of these 278 Implementation Guides are itemized in
the following distinct paragraphs.

The purpose of the Health Care Services Review Request for Review and
Response guide, 005010X217, is to transmit:
· admission certification review requests and associated responses
· referral review requests and associated responses
· health care services certification review requests and associated
responses
· extend certification review requests and associated responses
· certification appeal review requests and associated responses
· reservation of medical services requests and associated responses
· cancellations of service reservations requests and associated
responses.

The purpose of the Health Care Services Review Notification and
Acknowledgment guide, 005010X216, is to provide:
· advance notification of authorizations for planned or scheduled
admissions, health services, specialty referrals
· completion notification of admissions and discharges that have
occurred or the completion of the delivery of previously authorized
health care services
· information copy or courtesy copy to notify a receiving entity of a
health care services review outcome
· acknowledge receipt of a health care services review notification
or information copy.

The purpose of the Health Care Services Review Inquiry and Response
guide, 005010X215 is to:
· make inquiries to utilization management organizations for
information on previously processed health care services
· send responses to inquiries on previously processed health care
services.

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 last full week of September, 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 -- X12 member or not -- via the on-line
conference at: http://www.wpc-edi.com/conferences/healthcare.html .

The Health Care Services Review Request for Review and Response
Implementation Guide, 005010X217, is a newer version, 005010, of the
ones of the same title presently adopted under HIPAA, 004010 and
004010A1. The present plan is to propose the finalized version of this
draft guide, modified based on any public comments, as a new HIPAA
standard.

The Health Care Services Review Notification and Acknowledgement and
Health Care Services Review Inquiry and Response Implementation Guides
are not counterparts 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 these guides are published as
TR3's, 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 three guides is
open to all who may be interested; whether or not members of Accredited
Standards Committee X12. 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@...