The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the Secretary of HHS to adopt standards for administrative and financial transactions, including the health care claim and claims attachments. All health care providers that choose to submit the transactions electronically will be required to follow the standard, and all health plans will be required to accept the standard transactions. The NCVHS has recommended that the Secretary adopt the X12N 837 transaction set for the standard electronic health care claim. These hearings will explore current practices and recommended standard(s) for claims attachments in preparation for the NCVHS to make its recommendations on claims attachments to the Secretary.
1. What is your definition of a claim versus a claim attachment?
2. How should we differentiate information that is appropriate for the claim versus information that is appropriate for claims attachments?
3. What types of claims attachments do you currently request from providers? In what format do you make such requests? In what format do you receive this information?
4. What other types of documentation do you currently request from providers? In what format do you make such requests? In what format do you receive this information?
5. What purpose(s) do these attachments and other documentation serve?
6. What aspects of these processes would be aided by standardization and electronic exchange of information?
7. What aspects of these processes are not conducive to standardization?
8. What is the relationship between claims attachments and the medical record?
9. Do you ever request the entire medical record from providers in support of the claim? Under what circumstances is the entire medical record required?
10. Currently, the NUCC and the NUBC have the responsibility for approving the content of information contained in the standard health care claim. Do you think such an organization should also have responsibility for approving the content of claims attachments? Can you suggest which organization(s) should have this responsibility?
11. If there was a governing body over data content of the standard attachment data, there would have to be a protocol in place to add, delete, modify, etc. existing data content of the attachment. What are your suggestions/concerns regarding this process?
12. Do you currently require providers to submit information that is not part of the standard claim?
13. How do you intend to continue to collect information from providers that is not part of the X12N 837 health care claim?
14. Will states come together (e.g., under the aegis of the National Association of Health Data Organizations) to design a claims attachment that would serve their information needs in a standard way?
15. How can this Subcommittee help in this effort?
16. What types of claims attachments do you currently provide to payers? In what format do you provide such information?
17. What other types of documentation do you currently provide to payers? In what format do you provide this information?
18. What purpose(s) do these attachments and other documentation serve?
19. How much do these requests differ across payers? Could these requests for claims attachments and additional documentation be classified and standardized across payers?
20. What aspects of these processes would be aided by standardization and electronic exchange of information?
21. What is the relationship between claims attachments and the medical record?
22. Do you ever submit the entire medical record to payers in support of the claim? Under what circumstances is the entire medical record submitted?
23. Would standardization and simplification of the questions asked by the payer make the claim adjudication process easier?
24. Do you have any suggestions that would assist us in the task of standardizing the requests for additional information from payers?
25. Would the automation of health care claim attachment information and standardization of the payers' requests for information reduce operating costs for your facility?
26. Can you clearly differentiate “clinical information”, "claims information”, and “attachment information”?
27. Are there health care claim attachments that do not contain “clinical” information?
28. Currently, the NUCC and the NUBC have the responsibility for approving the content of information contained in the standard health care claim. Do you think such an organization should also have responsibility for approving the content of claims attachments? Can you suggest which organization(s) should have this responsibility?
29. If there was a governing body over data content of the standard attachment data, there would have to be a protocol in place to add, delete, modify, etc. existing data content of the attachment. What are your suggestions/concerns regarding this process?
30. What impact will the incorporation of HL7 messaging in the standardization of attachments have?
31. Does your automated information management system have the capability to create a standard electronic health care attachment?
32. (for hospitals) Would a standard claims attachment for State-mandated health care data reporting ease the reporting requirements for your facility?
33. What positive/negative impacts on existing systems would the inclusion of X12 and HL7 messaging in one standard have?
34. How common are systems that integrate information across departments so that electronic requests for clinical information can be fulfilled electronically, regardless of the data source?
35. What problems do you foresee in implementation of standards for health care claims attachments?