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ASC X12/HL7 ESMD AND DATA PAYLOAD STANDARDS Gary Beatty Deloitte Consulting
22

ASC X12/HL7 esMD and Data Payload Standards

Feb 22, 2016

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Page 1: ASC  X12/HL7 esMD and Data Payload  Standards

ASC X12/HL7ESMD AND DATA PAYLOAD STANDARDS

Gary BeattyDeloitte Consulting

Page 2: ASC  X12/HL7 esMD and Data Payload  Standards

2

GOAL OF ESMD

Page 3: ASC  X12/HL7 esMD and Data Payload  Standards

3

ESMD EVOLUTION

CMS: Paper Requests

Providers choose response type:• Paper• CD (PDF/TIFF)• Fax

Page 4: ASC  X12/HL7 esMD and Data Payload  Standards

4

ESMD EVOLUTION

CMS: Paper Requests

Providers:• Unstructured content XDR

Page 5: ASC  X12/HL7 esMD and Data Payload  Standards

5

ESMD EVOLUTION

CMS: Paper Requests

Providers:• Unstructured content X12 275/HL7 CDA

Page 6: ASC  X12/HL7 esMD and Data Payload  Standards

6

ESMD EVOLUTION

CMS: X12 277 Health Care Claim Request for Additional Information

Providers:• Unstructured

content X12/HL7

Page 7: ASC  X12/HL7 esMD and Data Payload  Standards

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ESMD EVOLUTION

CMS: X12 277 Health Care Claim Request for Additional Information

Providers:• Structured content X12 275/HL7

CDA

Page 8: ASC  X12/HL7 esMD and Data Payload  Standards

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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

Page 9: ASC  X12/HL7 esMD and Data Payload  Standards

277 AND 275 WORKING TOGETHER

9

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

Page 10: ASC  X12/HL7 esMD and Data Payload  Standards

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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

Page 11: ASC  X12/HL7 esMD and Data Payload  Standards

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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

Page 12: ASC  X12/HL7 esMD and Data Payload  Standards

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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

Page 13: ASC  X12/HL7 esMD and Data Payload  Standards

X12 ACKNOWLEDGMENTS

13

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

Page 14: ASC  X12/HL7 esMD and Data Payload  Standards

14

HL7 CLINICAL DOCUMENT ARCHITECTURE (CDA)

Structured Clinical Information Computer Decision Variant

Unstructured Clinical Information Human Decision Variant

Page 15: ASC  X12/HL7 esMD and Data Payload  Standards

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HL7 CDA BASIC STRUCTURE

<ClinicalDocument><body></body></ClinicalDocument>

Unstructured clinical information - packaged into a Multipart Mime package

Page 16: ASC  X12/HL7 esMD and Data Payload  Standards

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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>

Page 17: ASC  X12/HL7 esMD and Data Payload  Standards

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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>

Page 18: ASC  X12/HL7 esMD and Data Payload  Standards

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SAMPLE ESMD TRANSACTION

Example

Page 19: ASC  X12/HL7 esMD and Data Payload  Standards

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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)

Page 20: ASC  X12/HL7 esMD and Data Payload  Standards

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CDA TEMPLATES Reusable Abbreviated

Development Cycle Templates can be

transformed to source code

Data Entry Form

Page 21: ASC  X12/HL7 esMD and Data Payload  Standards

DischargeSummary

1

DischargeSummary

2Discharge

Summary

EHRTranslation

Standardization

Thesaurus

Style Sheet

Style Sheet

DischargeSummary

1

DischargeSummary

2

Page 22: ASC  X12/HL7 esMD and Data Payload  Standards

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Gary [email protected]

Thank you!