Health Care Attachments to Support Claims, Referrals and Authorizations

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Implementation Specification	ASC X12®N/006020X315 Health Care Services Request for Review and Response (278), September 2014 as an ASC X12 Standards for Electronic Data Interchange Technical Report Type 3	Final	Production		No	$	No
Implementation Specification	ASC X12N/006020X313 Health Care Claim Request for Additional Information (277), September 2014 as an ASC X12 Standards for Electronic Data Interchange Technical Report Type 3	Final	Production		No	$	No
Implementation Specification	ASC X12N/006020X316 Additional Information to Support a Health Care Services Review (275), September 2014 as an ASC X12 Standards for Electronic Data Interchange Technical Report Type 3	Final	Production		No	$	No
Implementation Specification	HL7 CDA® R2 Attachment Implementation Guide: Exchange of C-CDA Based Documents, Release 1 - US Realm	Final	Production		No	Free	No
Implementation Specification	HL7 CDA R2 Implementation Guide: Consolidated CDA Templates for Clinical Notes (US Realm) Draft Standard for Trial Use Release 2.1	Final	Production		No	Free	No
Implementation Specification	HL7 FHIR DaVinci Clinical Data Exchange (CDex) Implementation Guide	Balloted Draft	Pilot		No	Free
Implementation Specification	NCPDP SCRIPT Standard Implementation Guide Version 2023011	Final	Production	Feedback Requested	No	$	No

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
The HIPAA legislation requires adoption of a standard for health care attachments; the Affordable Care Act of 2010 reiterated this requirement. HHS has not proposed adoption of a standard for attachments to support claims and other administrative transactions to date (11/2021). Willing trading partners may exchange attachments through methods agreed upon by those organizations, including through different means of electronic exchange, and the use of standards. Pilots to test new standards for consideration to be adopted under HIPAA is permissible using the exception process under 162.940. CMS provides additional information about the HIPAA administrative simplification provisions on its website. HL7 DaVinci is testing an exception to the x12 278 with an API and submitted its report in July 2024.	Feedback requested.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

The HIPAA legislation requires adoption of a standard for health care attachments; the Affordable Care Act of 2010 reiterated this requirement. HHS has not proposed adoption of a standard for attachments to support claims and other administrative transactions to date (11/2021). Willing trading partners may exchange attachments through methods agreed upon by those organizations, including through different means of electronic exchange, and the use of standards.
Pilots to test new standards for consideration to be adopted under HIPAA is permissible using the exception process under 162.940.
CMS provides additional information about the HIPAA administrative simplification provisions on its website.
HL7 DaVinci is testing an exception to the x12 278 with an API and submitted its report in July 2024.

Comment

Submitted by pwilson@ncpdp.org on 2017-11-20

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 -