so you want to make a change — changing x12 materials — may, 2005

So You Want to Make a Change

Changing X12 Materials

May, 2005

So You Want to Make a Change TopicsProducts, Processes, and FormsSelected Processes DetailsTimings and SchedulesMore Details

X12 Products StandardsTransactions X12 Syntax EDIFACT Syntax XML SyntaxCommunications and ControlsCode SetsInternal code sets Sources for external code listscontinued on next slide

X12 Products Technical ReportsType 1 Tutorial [for one standard]Type 2 Reference Model [cross-standards]Type 3 Implementation Guide (IG) Adopted for HIPAA Not Adopted for HIPAAInterpretationsTransaction StandardsImplementation Guides [X12N/TG2 only]

Key Non-X12 Products External Code Lists; e.g., ICD-9 NDC Reason CodesCPT-4 CDT Remark CodesHCPCS DRG Revenue CodesNPlanID NPI Employer IDNAIC UPC Bank NumbersLOINC Taxonomy Error CodesZIP Codes States and Outlying Areas CodesCountries, Currencies and Funds CodesHIPAA Regulations

Key Non-X12 Products External Code Lists; e.g., ICD-9 NDC Reason CodesCPT-4 CDT Remark CodesHCPCS DRG Revenue CodesNPlanID NPI Employer IDNAIC UPC Bank NumbersLOINC Taxonomy Error CodesZIP Codes States and Outlying Areas CodesCountries, Currencies and Funds CodesSunday, noonSunday, 1pmRegular, non-X12, Code Committee Meetings that precede each X12 Meeting

X12 Change Paradigm Once X12 documents are published, they are never modifiedAll changes are incorporated into follow-on documentsNew standards versions; including complete lists of all internal code sets values and sources for external codes listsNew Implementation Guides (IG), IG Addenda, and IG Errata [X12N only]New Technical Reports (TR1, TR2, TR3)Differences from predecessor documents are noted

Most Common X12 Processes Data Maintenance (DM)Code Maintenance Request (CMR)X12N IG and TR3 DevelopmentHIPAA Change Request (CR)Request for Interpretation Implementation Guide (HIR) Transaction Standard (RFI)

Primary X12 Forms X12 Project ProposalNew X12 StandardRevised X12 Standard

continued on next slide

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 ____________________________________

Page Two

Part I PURPOSE AND SCOPE: This statement must indicate the full range of functionality of the new standard or guideline. List any limitations in scope. Explain the transaction or application to be covered. For a new transaction set, THE PURPOSE/SCOPE STATEMENT MUST BEGIN AS FOLLOWS: "This Draft Standard for Trial Use contains the format and establishes the data contents of the [title of the standard, transaction set ID] for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to..."

Part II BACKGROUND: Provide details that will be helpful in reviewing the proposal. Who are the expected users? How will the DSTU or guideline be used? What business function(s) does it serve or support? If the proposed standard overlaps the functionality of an existing standard or one in development, provide justification.

Part III OTHER STANDARDS INVOLVED: If applicable, identify any other business information standards that are similar/related to the proposal, and name standards developers (e.g., ANSI Accredited Standards Committees) whose activities may be involved or affected.

Part IV EXPECTED CONTENT/GENERAL DESCRIPTION: (OPTIONAL) Submitter may attach a preliminary draft of the proposed standard or other supporting documentation. Discuss new segments, data elements, control structures, and changes to X12.5, X12.6, X12.3 and X12.22 that are anticipated. (Use attachments.)

Primary X12 Forms X12 Work RequestRevised X12 StandardNew Technical ReportData Maintenance for a new or revised X12 Standard; but most new or revised code values may use the online CMR formonline version also availablecontinued on next slide

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:

Rev. 11/30/99

WR Form Page TwoDM NUMBER

(Secretariat Only)

FORM FOR NEW OR REVISED EXTERNAL CODE SOURCE REFERENCE

FOR X12.3 DATA ELEMENT DICTIONARY

INSTRUCTIONS:

Complete this form only when a new data element or data element code reference is requested to be added to Appendix A of X12.3 Data Element Dictionary which references a code list published by an organization external to X12. Use one form for each new or revised reference. This form may be used to revise current references; fill out the appropriate areas below.

PART 1: REFERENCE Check 1 or 2 below. If 2, fill in the blank.

(1) FORMCHECKBOX NEW REFERENCE

(2) FORMCHECKBOX REVISED REFERENCE, Current reference number/name

PART 2: REFERENCE TITLE

If there is only one source for codes for the data element, the title should be the same as the data element name. If there are multiple codes referencing external code sources for the same data element, title should approximate the code definition.

REFERENCE TITLE:

PART 3: DATA ELEMENTS USED IN

Give the data element reference number and name which directs the user to this code source. Give the code ID (if assigned) if this is for a specific code of the data element.

USED IN: DE No. , Code ID

PART 4: SOURCE

Provide the name of the publication which contains the codes referenced.

PUBLISHED IN:

PART 5: AVAILABLE FROM

Give the publisher, or other contact, from whom the user can obtain the document.

Name/Attn. of:

Company

Address

City State Zip+4

PART 6: URL (If available) http://www.

PART 7: ABSTRACT

Briefly describe the publication, its purpose, and indicate what codes it contains.

ABSTRACT:

Primary X12 Forms X12 Code Maintenance Request (CMR)New or revised X12 code values; except those in envelope segments ISA, IEA, GS, and GEOnline form only; available on the X12 web sitehttp://x12.org/x12org/X12Standards/CMR/SubmitterInformation.cfmcontinued on next slide

Primary X12 Forms 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)continued on next slide

Primary X12 Forms X12N Implementation Guide Project ProposalNew Implementation Guide (IG) [which may or may not become a new Type 3 Technical Report (TR3) ]Revised IG; i.e., IG AddendaIG Erratacontinued on next slide

Primary X12 Forms 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 coveredcontinued on next slide

Primary X12 Forms 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. RFIs should be sent to:Chair, Accredited Standards Committee X12 c/o Data Interchange Standards Association 7600 Leesburg Pike, Suite 430 Falls Church, Virginia 22043Attn: Request for X12 Interpretation

So You Want to Make a Change TopicsProducts, Processes, and FormsSelected Processes DetailsChanging an existing transaction standardAdding or changing an X12 code valueRequesting changes to an IG or TR3Creating a new IG or TR3Timings and SchedulesMore Details

Changing an Existing Transaction StandardUse Data Maintenance (DM) process forRevised transaction standardsNew or revised segmentsNew or revised data elementsNew or revised X12 code values New or revised non-X12 code sources New or revised control standardsMost new or revised X12 code values may be processed more rapidly using the online CMR processNew 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

Changing an Existing Transaction StandardData 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

Changing an Existing Transaction StandardData Maintenance (DM) Waypoints in X12N Work Request Form Process Secretariat DISA functions:Obtains X12N Chair or Vice-Chair signature on Work Request FormCopies signed Work Request FormSubmits original Work Request Form to DISA data base Update CenterReviews DM in DISA data base for accuracyAssigns and records DM numberPrepares for and runs DM Ballot Processhttp://x12.org/x12org/Subcommittees/PP/ASCPROC/sd4-published-1997.pdfSIDEBAR

Adding or Changing an X12 Code ValueUse Code Maintenance Request (CMR) process forNew or revised X12 code valuesNotes: 1. DM process may always be used if desired; its 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

Adding or Changing anX12 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

Requesting Changes to anIG or TR3If only an IG use collegial process (i.e., make change suggestions known to responsible / authoring work groups)and/orIf IG is also a TR3 use Work Request Form process and/orIf IG or TR3 is adopted under HIPAA use Designated Standards Maintenance Organizations (DSMO) online Change Request System (CRS)www.hipaa-dsmo.org/crs

Requesting Changes to aHIPAA IG or TR3DSMO 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


Requesting Changes to aHIPAA IG or TR3DSMO 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


Requesting Changes to aHIPAA IG or TR3DSMO 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 IGs responding to changes requested Participate at X12 Trimester Meeting Informational Forums for IGs responding to changes requested

Creating a New IG or TR3Use X12N IG Handbook Process forNew Insurance Subcommittee (X12N) Implementation Guide (IG) or new Type 3 Technical Report (TR3)Revised X12N IG AddendaErrata to an X12N IG Five phases

Creating a New IG or TR3IG 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/registrycontinued on next slide

Creating a New IG or TR3IG Process Waypoints in X12N 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}continued on next slide

Creating a New IG or TR3IG Process Waypoints in X12N 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}


Creating a New IG or TR3IG Process Waypoints in X12N 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


Creating a New IG or TR3IG Process Waypoints in X12N 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

Rule-of-Thumb Timings Approximate change processing timingfrom Start of Work through Publication Process X12 Flow Time CMR 8 12 months DM 1 or more years IG 1 2 years TR3 2 2 yearsPatient persistent participation is paramount.

Rule-of-Thumb TimingsIf DSMO Change Request System (CRS) Process used add an additional 4 months to two yearsIf HIPAA adoption required add an indeterminate amount of time forDSMO Steering Committee approvalNational Committee on Vital and Health Statistics (NCVHS) hearings and recommendationNotice of Proposed Rule Making (NPRM) preparation and public commentFinal Rule preparation180 day to three year compliance period following nominal 60 day Congressional Review period

Publication Schedules X12 Transaction and Code Set StandardsFixed, unvarying scheduleThree time-sequences each yearMaterials publishedPrimary Release JanuarySub-releases March and Julyhttp://x12.org/x12org/subcommittees/dev/PDF/X12RELEASESCHED.pdfcontinued on next slide

Publication Schedules Insurance Subcommittee (X12N) Implementation Guides (IG) and Type 3 Technical Reports (TR3)Property and Casualty Task Group (X12N/TG1)As neededHealthcare Task Group (X12N/TG2)Presumed virtually all need ongoing modificationUpdated approximately every two yearsRotating, staggered schedule [two dozen documents presently slotted into five time-sequences]http://x12.org/x12org/subcommittees/X12N/N0200_X12N005010_TR3.pdf

More DetailsX12 Standing Document 2 (SD2): Operations ManualDevelopment and Maintenance Procedures for Standards, Interpretations, Guidelines and Technical Reportshttp://x12.org/x12org/subcommittees/x12j/J0000_sd2.pdfHealthcare 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 standardshttp://x12.org/x12org/subcommittees/X12N/N0200_ASC_X12NTG2_Handbook.pdf


More DetailsProperty and Casualty Task Group Handbook http://x12.org/x12org/subcommittees/X12N/N0100_NTG1Handbook_jun02.PDFX12N Implementation Guide HandbookPolicies, Procedures, and Conventions for IG / TR3 Development, Review, and DistributionOne 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/continued on next slide

More DetailsDesignated Standards Maintenance Organizations (DSMO) Memorandum of Understanding (MOU)Joint document by X12, NCPDP, HL7, NUBC, NUCC, and DeCCOutlines cooperative framework for maintenance of HIPAA transactionshttp://hipaa-dsmo.org/mou.pdfX12 HIPAA Change Request Processing WorkflowFlow charts derived from DSMO MOUExpanded and personalized for X12Nhttp://x12.org/x12org/subcommittees/X12N/N0303_X12_HIPAA_Workflow.pdfcontinued on next slide

More DetailsHIPAA Transactions The Next TR3sThe follow-on to this presentationContact this presenter or X12N/TG3/WG3, HIPAA Implementation and Coordination, to arrange

HIPAA Transactions The Next TR3s TOPICS Materials used in HIPAA TCS Processes for Creating Materials Current Schedules Some Unanswered Questions

Questions?Comments?Smart Remarks?*So You Want to Make a Change Changing X12 Materials

So You Want to Make a Change

Changing X12 Materials

Prepared and Presented byDavid A. Feinberg, C.D.P.Insurance Education Task Group( X12N/TG11)

So You Want to Make a Change Changing X12 Materials Contacting the authorDavid A. Feinberg, C.D.P.Teacher, Insurance Education (X12N/TG11)Co-Chair, HIPAA Implementation and Coordination (X12N/TG3/WG3) Rensis [email protected]

Insurance Education (X12N/TG11) Training CatalogInsurance Subcommittee (X12N) IntroductionInsurance Subcommittee (X12N) CharterHealthcare Insurance Task Group (X12N/TG2) IntroductionCodes at X12Changing X12 MaterialsHIPAA and X12 [compliments of X12N/TG3/WG3]Extensible Markup Language (XML) IntroductionX12s Context Inspired Component Architecture (CICA) OverviewRoberts Rules of Orderas of February, 2005

so you want to make a change — changing x12 materials — may, 2005

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