Health Care Attachments to Support Claims, Referrals and Authorizations

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Type Standard / Implementation Specification Standards Process Maturity Implementation Maturity Adoption Level Federally required Cost Test Tool Availability
Standard
Final
Pilot
Rating 1
No
$
No
Implementation Specification
Final
Pilot
Rating 1
No
$
No
Implementation Specification
Final
Pilot
Rating 1
No
$
No
Implementation Specification
Final
Pilot
Rating 1
No
$
No
Implementation Specification
Final
Production
Rating 4
No
$
No
Implementation Specification
Final
Pilot
Rating 1
No
$
No
Implementation Specification
Final
Production
Rating 3
No
$
No
Implementation Specification
Balloted Draft
Pilot
Rating 1
No
$
No
Implementation Specification
Balloted Draft
Pilot
Rating 1
No
$
No
Implementation Specification
Final
Pilot
Rating 1
No
$
No
Implementation Specification
Final
Pilot
Rating 2
No
$
No
Implementation Specification
Final
Pilot
Rating 1
No
$
No
Limitations, Dependencies, and Preconditions for Consideration
Applicable Security Patterns for Consideration
  • The standards for attachments to support claims and other administrative transactions have not been adopted for use, though the original HIPAA legislation required their adoption, and the Affordable Care Act reiterated the requirement.  
  • A proposed rule was published in 2005, and a final rule was released in 2006, and then withdrawn.
  • There are at least two provider/payer partners who have implemented the attachment standards successfully, on a voluntary basis, following a pilot project in 2004.
  • CMS provides additional information about the HIPAA administrative simplification provisions. 

Feedback requested

Comment

NCPDP - Comment

  • This should be under the main category of V-D: Administrative Transaction to Support Clinical Care.
  • Add a bullet for Standards for referral certification and authorization transaction - Pharmacy

Type-Implementation Specification

Standard Implementation/Specification- NCPDP Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2010

Standards Process Maturity – Final

Implementation Maturity- Production

Adoption Level – 3

Federally Required – Yes

Cost – $

Test Tool Availability –

  • Add a bullet for Standards for referral certification and authorization transaction - Pharmacy

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard Implementation Guide, Version 2013101

Standards Process Maturity – Final

Implementation Maturity- Production

Adoption Level – 2

Federally Required – Yes

Cost – $

Test Tool Availability -

The very large list of…

The very large list of standards in this section suggests that it should be broken up into different interoperability needs. There also seems to be a mix of base standards (X12 Version 6020), implementation guides specific to attachments, and some other general implementation guides that probably don’t need to be listed here because they are pointed to in the attachment specific guides (C-CDA, LOINC Document Ontology IG, Digital signatures, etc). Previously, the HITSC recommended separating out base standards from implementation guides.