1 So You Want to Make a Change — Changing X12 Materials — So You Want to Make a Change — Changing X12 Materials — May, 2005

1

So You Want to Make a ChangeSo You Want to Make a Change

— — Changing X12 Materials Changing X12 Materials ——

May, 2005

2

So You Want to Make a Change So You Want to Make a Change

TopicsTopics

• Products, Processes, and Forms

• Selected Processes Details

• Timings and Schedules

• More Details

3

X12 Products X12 Products

• Standards– Transactions

X12 Syntax EDIFACT Syntax XML Syntax

– Communications and Controls

• Code Sets– Internal code sets – Sources for external code lists

continued on next slide

4

X12 Products X12 Products

• Technical Reports– Type 1 – Tutorial [for one standard]– Type 2 – Reference Model [cross-standards]– Type 3 – Implementation Guide (IG)

• Adopted for HIPAA • Not Adopted for HIPAA

• Interpretations– Transaction Standards– Implementation Guides [X12N/TG2 only]

5

Key Key Non-X12Non-X12 Products Products

• External Code Lists; e.g., – ICD-9 – NDC – Reason Codes– CPT-4 – CDT – Remark Codes– HCPCS – DRG – Revenue Codes– NPlanID – NPI – Employer ID– NAIC – UPC – ‘Bank’ Numbers– LOINC – Taxonomy – Error Codes– ZIP Codes – States and Outlying Areas Codes– Countries, Currencies and Funds Codes

• HIPAA Regulations

6

Key Key Non-X12Non-X12 Products Products

• External Code Lists; e.g., – ICD-9 – NDC – Reason Codes– CPT-4 – CDT – Remark Codes– HCPCS – DRG – Revenue Codes– NPlanID – NPI – Employer ID– NAIC – UPC – ‘Bank’ Numbers– LOINC – Taxonomy – Error Codes– ZIP Codes – States and Outlying Areas Codes– Countries, Currencies and Funds Codes

Sunday, noon Sunday, 1pmRegular, non-X12, CodeCommittee Meetings thatprecede each X12 Meeting

7

X12 Change Paradigm X12 Change Paradigm

• Once X12 documents are published, they are never modified

• All changes are incorporated into follow-on documents– New standards versions; including complete lists of all

internal code sets values and sources for external codes lists

– New Implementation Guides (IG), IG Addenda, and IG Errata [X12N only]

– New Technical Reports (TR1, TR2, TR3)• Differences from predecessor documents are noted

8

Most Common X12 Processes Most Common X12 Processes

• Data Maintenance (DM)

• Code Maintenance Request (CMR)

• X12N IG and TR3 Development

• HIPAA Change Request (CR)

• Request for Interpretation– Implementation Guide (HIR)– Transaction Standard (RFI)

9

Primary X12 Forms Primary X12 Forms

• X12 Project Proposal– New X12 Standard

– Revised X12 Standard


rev. 1/24/96 PP No. ________________________ (Secretariat Only)

ASC X12

NEW PROJECT PROPOSAL FORM for X12 DEVELOPMENT PROJECTS

PROCEDURE: Only X12 subcommittees may use this form to register new development activities as X12 project proposals (PPs).

Complete all pages. PPs approved by the X12 Procedures Review Board will be registered and assigned a PP number by the Secretariat

and a Transmittal Form will be issued. Date and complete the form. Type or print legibly in black ink and number all attachment pages

consecutively.

SUBMISSION: Submit to the Secretariat at least 35 days in advance of a trimester X12 meeting for distribution to the PRB. For

submission at an X12 meeting, refer to Procedures Review Board documentation requirements.

Date Submitted to DISA: ________________________________ Associated DM (if any): ________________________________ Date Approved by Subcommittee: ________________________________ SC Officer Initials: ________ Subcommittee Name: ________________________________ Task Group Number and Name: ________________________________ Joint Development Subcommittee (if any): ______________________ INDICATE ONE: (a) X12 Transaction Set (c) X12 Control Structures (b) X12 Management Transaction Set (d) X12 Guideline INDICATE ONE: Transaction Set is Interactive ___ Yes ___No Transaction Set is X12 Syntax ___ Yes ___No Project Working Title: _______________________________________________________________________ _______________________________________________________________________ Project Delegate for This Project To Be Named on Transmittal Form (Only one alternate may be designated.): Primary: Alternate: Name ______________________________________ Name ________________________________________

Company ___________________________________ Company _____________________________________

Address ____________________________________ Address ______________________________________

Address ____________________________________ Address ______________________________________

Address/ZIP ______________________/ZIP+4_____ Address/ZIP ________________________/ZIP+4_____

Telephone __________________________________ Telephone ____________________________________

10


• X12 Work Request– Revised X12 Standard

– New Technical Report

– Data Maintenance for a new or revised X12 Standard; but most new or revised code values may use the online CMR form

Rev. 3/24/99

Date Submitted DM NUMBER (Submitter Provide) (Secretariat Only)

ASC X12 WORK REQUEST FORM

A. SUBMITTER INFORMATION:

Submitter Name: Company:

Address: Address: Zip+4

Phone: E-mail:

Submission represents the position of: SC Chair Initials:

B. REFERENCE USED: Version /Release /Subrelease or Workbook (date)

C. INTENDED USE:

Transaction Set(s):

Segment(s):

Composite Data Element(s):

Data Element(s):

Code Source(s):

Other:

D. BUSINESS CASE/REASON FOR CHANGE:

E. PROPOSED WORK:

online version also available


11


• X12 Code Maintenance Request (CMR)– New or revised X12

code values; except those in envelope segments ISA, IEA, GS, and GE

– Online form only; available on the X12 web site

http://x12.org/x12org/X12Standards/CMR/SubmitterInformation.cfm


12


• X12 Transmittal FormRecords the dates of the review and approval levels achieved for a particular development project by / at:– Subcommittee(s)– Project Delegate(s)– Secretariat (DISA)– Technical Assessment

(TAS) (X12J)– Procedures Review Board

(PRB)


13


• X12N Implementation Guide Project Proposal– New Implementation

Guide (IG) [which may or may not become a new Type 3 Technical Report (TR3) ]

– Revised IG; i.e., IG Addenda

– IG Errata


14


• Request for Interpretation of X12N Implementation Guide (HIR)– There is no form. The submitter uses the interactive database at http://x12n.org/portal

– Initially [November, 2004], only the nine X12N Implementation Guides and their Addenda adopted under HIPAA are covered

ASC X12N/TG2 Interpretations Portal

Register Search Login Help


15


• Request for Interpretation of X12 Transaction Standard (RFI)– There is no form. The submitter sends a letter providing “a comprehensive description of the aspect of the standard that needs interpretation and provides a business case to explain the need for the interpretation. The affected standard is specified by title, reference number(s), version/release, and publication date.”

– RFI’s should be sent to:Chair, Accredited Standards Committee X12c/o Data Interchange Standards Association7600 Leesburg Pike, Suite 430Falls Church, Virginia 22043

Attn: Request for X12 Interpretation

16


TopicsTopics


• Selected Processes Details• Changing an existing transaction standard• Adding or changing an X12 code value• Requesting changes to an IG or TR3• Creating a new IG or TR3


• More Details

17

Changing an Existing Changing an Existing Transaction StandardTransaction Standard

Use Data Maintenance (DM) process for– Revised transaction standards– New or revised segments– New or revised data elements– New or revised X12 code values †

– New or revised non-X12 code sources ‡

– New or revised control standards

† Most new or revised X12 code values may be processed more rapidly using the online CMR process

‡ New or revised non-X12 code values only processed by their owning organizations; i.e., only the non-X12 code sources may make their code values changes

18


Data Maintenance (DM) Waypoints in X12N Work Request Form Process

Work Group Architecture Task Group (TG8) Parent Task Group (TG1 or TG2) Insurance Subcommittee (X12N) Secretariat – Data Interchange Standards Association

(DISA) [functions shown on next slide] Technical Assessment Subcommittee (TAS) (X12J) Procedures Review Board (PRB) X12 DM Ballot Process [a saga unto itself] Publisher – DISA

http://disa.org/bookstore/public/index.cfm

19


Data Maintenance (DM) Waypoints in X12N Work Request Form Process

Secretariat – DISA – functions:– Obtains X12N Chair or Vice-Chair signature on Work Request

Form– Copies signed Work Request Form– Submits original Work Request Form to DISA data base Update

Center– Reviews DM in DISA data base for accuracy– Assigns and records DM number

– Prepares for and runs DM Ballot Process

http://x12.org/x12org/Subcommittees/PP/ASCPROC/sd4-published-1997.pdf

SIDEBAR

20

Adding or Changing an Adding or Changing an X12 Code ValueX12 Code Value

Use Code Maintenance Request (CMR) process for– New or revised X12 code values

Notes: 1. DM process may always be used if desired; it’s just usually not as rapid as CMR 2. DM process must be used for code values contained in envelope segments ISA, IEA, GS, and GE 3. DM process must be used to create new code

values that identify non-X12 code sources

21

Adding or Changing anAdding or Changing anX12 Code Value X12 Code Value

Code Maintenance Request (CMR) Waypoints Submit CMR via online form

http://x12.org/x12org/X12Standards/CMR/SubmitterInformation.cfm

X12 CMR Ballot Process [approve unless excepted]

Technical Assessment Subcommittee (TAS) (X12J)

Procedures Review Board (PRB)

Publisher – Data Interchange Standards Association (DISA)

http://disa.org/bookstore/public/index.cfm

22

Requesting Changes to anRequesting Changes to anIG or TR3IG or TR3

A. If only an IG – use collegial process (i.e., make change suggestions known to responsible / authoring work groups)

and/or

B. If IG is also a TR3 – use Work Request Form process and/or

C. If IG or TR3 is adopted under HIPAA – use Designated Standards Maintenance Organizations’ (DSMO) online Change Request System (CRS) www.hipaa-dsmo.org/crs

23

Requesting Changes to aRequesting Changes to aHIPAA IG or TR3HIPAA IG or TR3

DSMO Change Request System (CRS) Process Register and log-in at www.hipaa-dsmo.org/crs Submit information requested

General section X12-specific section

Wait until approximately the middle of the month following the date request was submitted and then check which DSMO have expressed interest – X12 better be one of them


24


DSMO Change Request System (CRS) Process Wait approximately another three months and

then check the proposed solutions from each of the DSMO that have expressed interest – X12 included

Wait approximately another month and then check the approved solution

Watch for various extensions during the preceding two steps and adjust as necessary


25


DSMO Change Request System (CRS) Process Timely enter an objection if the approved

solution is not satisfying Attend X12 Trimester Meetings to watch

and/or participate in sausage being made Participate in Public Comment Periods for IG’s

responding to changes requested Participate at X12 Trimester Meeting

Informational Forums for IG’s responding to changes requested

26

Creating a New IG or TR3Creating a New IG or TR3

Use X12N IG Handbook Process for– New Insurance Subcommittee (X12N)

Implementation Guide (IG) or new Type 3 Technical Report (TR3)

– Revised X12N IG – Addenda– Errata to an X12N IG

• Five phases

27


IG Process Waypoints in X12N

I. Project Initiation – IG Project Proposal Form Work Group Parent Task Group (TG1 or TG2) Implementation Guide Task Group (TG4) Any other affected Subcommittees Registrar – Washington Publishing Company

www.wpc-edi.com/registry


28



II. Draft IG Creation and Approval Work Group and any other affected Subcommittees

IG contents {N-1,2}

Changes to Underlying Standards, if needed – follow applicable DM and/or CMR processes

Architecture Task Group (TG8) {N-3}

Implementation Guide Task Group (TG4) {N-4}

Publisher – Washington Publishing Company {N-5}


29



III. Public Comment Process Work Group Announcement {N-6}

Public Comment Period www.wpc-edi.com/products/publications

www.wpc-edi.com/edi_standards/asc_x12/conferences Work Group and other affected Subcommittees {N-7,8}

Work Group Announcement {N-9}

Informational Forum {N-10}

Work Group and other affected Subcommittees {N-11}


30



IV. Final IG Creation and Approval Work Group and other affected Subcommittees {N-12}

Parent Task Group (TG1 or TG2) {N-13}

Implementation Guide Task Group (TG4) {N-14}

Insurance Subcommittee (X12N) {N-15}

Publisher – Washington Publishing Company {N-16} www.wpc-edi.com/products/publications

If only IG … done; if TR3 … continue


31



V. TR3 Approval – X12 Work Request Form Work Group {N-17}

Any other affected Subcommittees {N-18}

Technical Assessment Subcommittee (TAS) (X12J) {N-

19}

Procedures Review Board (PRB) {N-20}

Publisher – Washington Publishing Company {N-21} www.wpc-edi.com/products/publications

32


TopicsTopics




• More Details

33

Rule-of-Thumb TimingsRule-of-Thumb Timings

Approximate change processing timing

from Start of Work through Publication

Process X12 Flow Time

CMR 8 – 12 months

DM 1 or more years

IG 1½ – 2 years

TR3 2 – 2½ years

Patient persistent participation is paramount.

34

Rule-of-Thumb TimingsRule-of-Thumb Timings

• If DSMO Change Request System (CRS) Process used …

add an additional 4 months to two years

• If HIPAA adoption required …add an indeterminate amount of time for

– DSMO Steering Committee approval– National Committee on Vital and Health Statistics

(NCVHS) hearings and recommendation– Notice of Proposed Rule Making (NPRM) preparation

and public comment– Final Rule preparation– 180 day to three year compliance period following

nominal 60 day Congressional Review period

35

Publication Schedules Publication Schedules

• X12 Transaction and Code Set Standards• Fixed, unvarying schedule

• Three time-sequences each year

• Materials published

– Primary Release January

– Sub-releases March and July• http://x12.org/x12org/subcommittees/dev/PDF/X12RELEASESCHED.pdf


36

Publication Schedules Publication Schedules

• Insurance Subcommittee (X12N) Implementation Guides (IG) and Type 3 Technical Reports (TR3)– Property and Casualty Task Group (X12N/TG1)

• As needed

– Healthcare Task Group (X12N/TG2)• Presumed virtually all need ongoing modification• Updated approximately every two years• Rotating, staggered schedule

[two dozen documents presently slotted into five time-sequences]• http://x12.org/x12org/subcommittees/X12N/N0200_X12N005010_TR3.pdf

37


TopicsTopics




• More Details

38

More DetailsMore Details• X12 Standing Document 2 (SD2):

Operations Manual– Development and Maintenance Procedures for Standards,

Interpretations, Guidelines and Technical Reports– http://x12.org/x12org/subcommittees/x12j/J0000_sd2.pdf

• Healthcare Task Group Handbook – Provides guidance to the members of the Healthcare

Insurance Task Group (X12N/TG2) to promote understanding and consistency during the development of healthcare standards

– http://x12.org/x12org/subcommittees/X12N/N0200_ASC_X12NTG2_Handbook.pdf


39

More DetailsMore Details

• Property and Casualty Task Group Handbook – http://x12.org/x12org/subcommittees/X12N/N0100_NTG1Handbook_jun02.PDF

• X12N Implementation Guide Handbook– Policies, Procedures, and Conventions for

IG / TR3 Development, Review, and Distribution– One for each X12 primary release; i.e.,

005010, 005020, 005030, etc.– http://www.wpc-edi.com/docman/task,view_category/Itemid,264/subcat,2/catid,75/limitstart,0/limit,10/


40

More DetailsMore Details• Designated Standards Maintenance Organizations

(DSMO) Memorandum of Understanding (MOU)– Joint document by X12, NCPDP, HL7, NUBC, NUCC, and

DeCC– Outlines cooperative framework for maintenance of HIPAA

transactions– http://hipaa-dsmo.org/mou.pdf

• X12 HIPAA Change Request Processing Workflow– Flow charts derived from DSMO MOU– Expanded and personalized for X12N– http://x12.org/x12org/subcommittees/X12N/N0303_X12_HIPAA_Workflow.pdf


41

More DetailsMore Details

• HIPAA Transactions – The Next TR3’s– The follow-on to this presentation

– Contact this presenter or X12N/TG3/WG3, HIPAA Implementation and Coordination, to arrange

HIPAA Transactions – The Next TR3’s

TOPICS • Materials used in HIPAA TCS • Processes for Creating Materials • Current Schedules • Some Unanswered Questions

X12N New Attendee Orientation

Questions?Questions?

Comments?Comments?

Smart Remarks?Smart Remarks?

42



43



Prepared and Presented byDavid A. Feinberg, C.D.P.

Insurance Education Task Group( X12N/TG11)

44

So You Want to Make a ChangeSo You Want to Make a Change— — Changing X12 Materials Changing X12 Materials ——

Contacting the author

David A. Feinberg, C.D.P.Teacher, Insurance Education (X12N/TG11)Co-Chair, HIPAA Implementation and Coordination (X12N/TG3/WG3) Rensis [email protected]

45

Insurance Education (X12N/TG11) Insurance Education (X12N/TG11) Training CatalogTraining Catalog

Insurance Subcommittee (X12N) Introduction

Insurance Subcommittee (X12N) Charter

Healthcare Insurance Task Group (X12N/TG2) Introduction

Codes at X12

Changing X12 Materials

HIPAA and X12 [compliments of X12N/TG3/WG3]

Extensible Markup Language (XML) Introduction

X12’s Context Inspired Component Architecture (CICA) Overview

Robert’s Rules of Order

as of February, 2005

Documents

1 So You Want to Make a Change — Changing X12 Materials — So You Want to Make a Change — Changing X12 Materials — May, 2005