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HIPAA Transactions and Code Sets

HIPAA Claims Attachments

ATTACHMENTS ARE HERE!

The following is an announcement from CMS:

On September 23, 2005, the proposed rule adopting standards for electronic health care claims attachments was published in the Federal Register. Health care claims attachments are those documents and information required by health plans to adjudicate certain claims. The proposed rule, mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) adopts two new X12 transaction standards, an HL7 messaging standard to carry clinical information in the response transaction, and HL7 specifications for the content or 'questions' that may be asked in each of the six attachment types. This proposed rule also adopts the Logical Observation Identifiers Names and Codes (LOINCŪ) as a new HIPAA code set to be used to identify the questions and answers (attachment information).

The standards allow for the transmission of structured or coded data, as well as images and text. The proposed rule solicits comments from the affected industries on several key issues, including the adoption of LOINCŪ and its use for the HIPAA transactions, the appropriateness of the six proposed attachment types, business requirements for attachments that would accompany the original claim (unsolicited attachments), and the cost-benefit implications of adopting this transaction set. The public comment period is open until November 22.

The Proposed Rule

VUMC'S TASKS TO DO NOW:

Read the NPRM (proposed rule above).

Read the X12 and HL7 specifications referenced in it.

Read the HL7 Whitepaper on Claims Attachments if you'd like more background information

Read the Vanderbilt comments sent to CMS in January 2006

This page was last updated February 8, 2006 and is maintained by