Review the 277 / 275 semantic XML schema and the draft licensing plan from X12. Form recommendations.
- Jim Taylor (X12): Based on initial request by the Innovation Message Group, this plan is currently being championed.
- The application is now in test, taking the 275 in an XML format (based on data required).
- The goal to have this in the format agreed upon by trading partners.
- The next step is validation and testing.
- X12 is asking all members of the Innovation Messaging Group to log in to the sign on page with the schema for testing and provide feedback on viability as well as anything that may need to be included. This group is best positioned to test the schema so that it can be set on the correct course from initial release.
- More info on testing the X12 Schema: X12 has announced that they are sponsoring a Phase 1 Beta Testing for the XML schema layout for the 275 attachment transaction.
How do I obtain a copy of the schema?
You must register at X12.org in order to download the license for the schema layout.
What is the expectation of me?
Share the schema with your IT and business teams, let them look it over and get their feedback. What do the like, don’t like and what is missing or needs to be changed. Note their comments and submit them back for review. The email address to send your comments to is TBD.
How can this schema be used?
This can support various types of attachments. Think outside of just claims. Claims is one, but if known, prior auth medical records, it could be used as solicited or unsolicited.
How long is this review period?
The initial review will last up to 1 year depending upon the comments/feedback received. It is understood that it may take up to 6 month to get the resources available to participate in the review.
Who can participate, do you have to be an X12 member?
No you do not have to be an X12 member. This is open to the general public, anyone can participate, the more folks in the industry that has eyes on this the better the product.
What happens after the Phase 1 Beta testing review?
Once the feedback is received, the various work groups will review and determine what changes were proposed and which may be accepted. Then a Phase 2 will include identifying willing trading partner to put the schema to real life testing. There is NOT a time table as of yet for this as it all is dependent upon the feedback/comments.
X12 wants to get the industry involved in this process. This is something totally new for X12 and feels strongly that with industry involvement earlier in the process, a usable product can be produced but we need the involvement of this group of industry experts.
What is the next endeavor to consider in the future?
Patient consent messaging, creating an industry standard. This may include approval to share clinical data, obtain clinical data or acknowledge receipt of DME equipment (hospital bed, wheel chair).
Additional use cases:
- Prior Auth is getting the most attention in current efforts to improve clinical data exchange, especially around the need to get additional information for approval
- The 270/275 were put in place when there were fewer use cases so it is important for the group to provide feedback so that there are genuine industry-expert voices.
Discuss the Davinci project’s efforts to automate providers’ retrieval of prior authorization and/or payment criteria
Payer/EMR collaboration – the Davinci project may provide a mechanism to inform providers what information will be required for prior authorizations (implementation guides are out for review over the two use cases)
Discuss standardization of patient consent for retrieval of clinical information from non-covered entities (SSA, Life Insurance companies)
- As a group, should we start working on the consent side?
- Get signed consent document to the EMR. For payers, e-signature is becoming more and more important (e-sig and e-sig notification).
- Input from the group:
- Would be interesting to look into (e-sigs are starting to become more popular outside of the health world; why not explore that for our industry)?
- Enables provider to sign without having to exit their current workflow
- Often times, providers send bare minimum to payers but payers often require more information.
- Vendor side doesn’t currently do this in health, but it is a gap. Plus side is it does work well in other areas.
- It is a good driver.
- From a business standpoint: this is a big need. From a consumer of medical healthcare services: absolutely. Let’s set the standards.
- If there is clearly a need here, what is the reason NOT to investigate this?
- The use case for electronic transactions described seems like an outlier, in terms of volume. Unless you have a high-volume patient-facing business model, it seems like a distraction from the main process under discussion.
- To be continued in our next discussion
- John Konczyk, New York Life
- Martin Jensen, MyHealth Access
- Michael Dale, TransUnion
- Leslie Elsarboukh, Anthem
- Jennifer Pacheco, Optimity Advisors
- Zane Schott, Apria
- Roxanne Hanson, Optum
- Jeff Taylor, X12
- Cara Barry, Availity
- Dave Kraft, Country Meadows
- Murali Athuluri, MAeHC
- John Bartley, SES
- Isabella Beaton, SES
- Stuart Beaton, HIT Consultant
- Dan Kazzaz, SES
- Lisa Savicki Basham, Humana
- Michele Barry, Availity
- Teresa Autery, TIBCO
- Susan Titterington, Practice Insight
- David Collins, United Health
- Department of Defense