ASC X12/HL7 esMD and Data Payload Standards
Post on 22-Feb-2016
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ASC X12/HL7ESMD AND DATA PAYLOAD STANDARDS
Gary BeattyDeloitte Consulting
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GOAL OF ESMD
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ESMD EVOLUTION
CMS: Paper Requests
Providers choose response type:• Paper• CD (PDF/TIFF)• Fax
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ESMD EVOLUTION
CMS: Paper Requests
Providers:• Unstructured content XDR
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ESMD EVOLUTION
CMS: Paper Requests
Providers:• Unstructured content X12 275/HL7 CDA
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ESMD EVOLUTION
CMS: X12 277 Health Care Claim Request for Additional Information
Providers:• Unstructured
content X12/HL7
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ESMD EVOLUTION
CMS: X12 277 Health Care Claim Request for Additional Information
Providers:• Structured content X12 275/HL7
CDA
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X12 TRANSACTIONS
HIH MedicareGateway
837 Health Care Claim
277 Health Care Claim Request for Additional Information
275 Additional Information to Support a Health Care Claim or Encounter
ASC X12 275 - 005010X210ASC X12 277 – 005010X213
277 AND 275 WORKING TOGETHER
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A 277 asks for
• Entire Attachmentor• Section/Entry of Attachments
A 275 Returns
• Section/Entry of AttachmentsConsisting of• Answer part(s)
Electronic Attachment
Section/EntrySection/EntrySection/Entry
Section/EntrySection/EntrySection/Entry
Section/EntrySection/Entry Answer Part
Section/Entry Answer PartSection/Entry Answer Part
- By sending LOINC - Identified using LOINC
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277 HEALTH CARE CLAIM REQUEST FOR ADDITIONAL INFORMATION
Loop ID Loop Name Loop Repeat
2000A Payer Name Loop 1
2000B Information Receiver Loop 1
2000C Service Provider Information Loop >1
2000D Patient Loop >1
2100D Patient Name Loop 1
2200D Payer Claim Control Number >1 Claim Level Status Information >1
2210D Claim Supplemental Information 1
2220D Service Line Information >1 Service Level Status Information >1
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275 ADDITIONAL INFO TO SUPPORT A HEALTH CARE CLAIM OR ENCOUNTER
Loop ID Loop Name Loop Repeat
1000A Payer Name 11000B Submitter Information
11000C Provider Name Information 1
1000D Patient Name 1
2000A Assigned Number >1
2100A Service Line Date of Service 1
2100B Additional Information – Submission Date 1
2110B Electronic Information Identification 1
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INTERCHANGE CONTROL STRUCTURE
Message Envelope (CORE Connectivity Rule SOAP)
ASC X12 Interchange Control Header
ASC X12 Functional Group Header
ASC X12 Transaction Set Control Trailer
Message E
nvelope (CO
RE
Connectivity R
ule SO
AP
)
Interchange Envelope
Functional Group E
nvelope
Message Envelope (CORE Connectivity Rule SOAP)
ASC X12 Interchange Control Trailer
ASC X12 Functional Group Trailer
ASC X12 Transaction Set Control Trailer
275 with PDF in HITSP C62 (1 Beneficiary / 1 Claim)
Transaction
Transport Protocol (H
TTP)
Binds to
X12 ACKNOWLEDGMENTS
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HIH MedicareGateway
837 Health Care Claim
277 Health Care Claim Request for Additional Information
275 Additional Information to Support a Health Care Claim or EncounterTA1 / 999 Negative Acknowledgment
834 Positive / Negative Acknowledgment
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HL7 CLINICAL DOCUMENT ARCHITECTURE (CDA)
Structured Clinical Information Computer Decision Variant
Unstructured Clinical Information Human Decision Variant
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HL7 CDA BASIC STRUCTURE
<ClinicalDocument><body></body></ClinicalDocument>
Unstructured clinical information - packaged into a Multipart Mime package
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ESMD METADATA WITHIN HL7 CDAMetadata HL7 CDA Author <Author>Person <assignedAuthor>Author Institution <representedOrganization>Class Code <code>Class Code Display Name <title>Confidentiality Code <confidentialityCode>Creation Time <effectiveTime>entryUUID <id>Healthcare Facility Type Code
<representedOrganization><typeId>
Healthcare Facility Type Code Display Name
<representedOrganization><name>
Language Code <languageCode>Patient ID <recordTarget><patientRole><patient
><id>
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ESMD METADATA WITHIN HL7 CDAMetadata HL7 CDA Practice Setting Code <healthCareFacility>
code <= ServiceDeliveryLocationRoleType
Practice Setting Code Display Name
<healthCareFacility> code <= ServiceDeliveryLocationRoleType
Service Start TimeService Stop Time
<DocumentationOf><ServiceEvent><effectiveTime>
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SAMPLE ESMD TRANSACTION
Example
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CDA TEMPLATES XML Based Single Imp. Guide Template is set of
constraints on full CDA standard
Computer Decision Variant (Structured Data)
Human Decision Variant (Unstructured Data)
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CDA TEMPLATES Reusable Abbreviated
Development Cycle Templates can be
transformed to source code
Data Entry Form
DischargeSummary
1
DischargeSummary
2Discharge
Summary
EHRTranslation
Standardization
Thesaurus
Style Sheet
Style Sheet
DischargeSummary
1
DischargeSummary
2
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Gary Beattygbeatty@deloitte.com
Thank you!
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