EsMD Harmonization UC2 Data Element Prioritization 8/1/2012.

Slides:



Advertisements
Similar presentations
What is proper format for the XDW document. In its first year, XDW has been exposed to feedback, and this public comment phase –to allow clarifications.
Advertisements

LDAP / HPD mapping to Provider Directory Data Elements
MITA Gateway 5010 Overview May 18th 2009.
Request Management Mirror-. A random three day sample of Incidents revealed that about 86% of the registered Incidents were legitimate Requests Many other.
Quality Measures Vendor Tiger Team December 13, 2013.
Electronic Submission of Medical Documentation (esMD) Face to Face Informational Session esMD Requirements, Priorities and Potential Workgroups – 2:00pm.
©2011 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Georgia Medicaid Fair Crossovers Presentation.
Reviewing the World of HIPAA Stephanie Anderson, CPC October 2006.
2 Agenda Goals of documentation training Iowa Administrative Code SURS Reviews Questions & answers.
1 Operating Rules Status NCVHS Subcommittee on Standards December 3, 2010 Updated on enhancements to Operating Rules for Eligibility and Claim Status.
PPA Use Case Context Diagram – Information Exchange Paths – General Case 0 Payer Organization Payer Organization Provider / Provider Organization Contractors.
Electronic Submission of Medical Documentation (esMD) for Medicare FFS Presentation to HITSC Provenance Workgroup January 16, 2015.
Electronic Submission of Medical Documentation (esMD) to DirectTrust.org December 3, 2014.
S&I Framework Provider Directories Initiative esMD Work Group October 19, 2011.
Denials Management. Objectives To understand the types of denials. Describe the Appeal Process. Learn Denial Prevention strategies. Differentiate between.
EsMD Harmonization Use Case 1: Initial Technical Approach HPD Plus Erik Pupo.
ETravel Authorization / Reimbursement Overview SOLAR Financials x 6685 July 8, 2014.
Customer Service Module Course Contents Table of Contents Enter A Request Search A Request Create Invoice (Funeral home request) Search Invoice Manage.
EsMD Harmonization WG Meeting Wednesday, June 13 th, 2012.
EsMD Background Phase I of esMD was implemented in September of It enabled Providers to send Medical Documentation electronically Review Contractor.
Security Standards under Review for esMD. Transaction Timeline An esMD transaction begins with the creation of some type of electronic content (e.g. X12.
Electronic Submission of Medical Documentation (esMD) Face to Face Informational Session Charter Discussion – 9:30am – 10:00am October 18, 2011.
(updated for esMD on ) electronic submission of Medical Documentation (esMD) HL7 Structured Documents and HL7 Attachments May 5-9, 2013 (updated.
Info Day on New Calls and Partner Café Brussels 10 February 2011 Application Form – Priority 1,3 How to ensure that your proposal is eligible?
ESPON 2013 Programme Info Day on Calls and Partner Café Brussels, 10 May 2012 How to apply: Application Form and Eligibility A Decade of Territorial.
2 nd Steering Committee Meeting October 2008, Athens and Aegina.
IDM Chapter 104 Utility Coordination Joe Gundersen Senior Utility Engineer, INDOT August 21, 2014.
Copyright © 2008, 2005, by Saunders, an imprint of Elsevier Inc. All rights reserved. The Health Insurance Claim Form Chapter 20.
EsMD Structured Content Use Case 2 WG Meeting Wednesday, April 25 th, 2012.
REVIEW OF CMS “INITIAL APPROVAL” OF RHP PLAN AND FOLLOW-UP REQUIREMENTS May 8, 2013 REGION 10.
Looking for Improper Medicare Payments in All the Right Places.
Referral request - data classification Patient information – Patient demographics, covered by MU2 and CCDA requirements – Patient identifier (Med Rec Number)
Prepaid CCN Encounter Data April 18, 2011 Sharon Jackson Darlene White.
Facilitator: Kit Cairns, WIITTS 5010 Working Session It's Time to Get Techie.
Electronic Submission of Medical Documentation (esMD) January 11, :00 PM – 3:00 PM Community Meeting 0.
New York State Health Homes Implementation and Billing Update Statewide Webinar Presented by: New York State Department of Health January 12,
EsMD Use Case 1: Introduction to Harmonization 1.
Interoperability Framework Overview Health Information Technology (HIT) Standards Committee June 24, 2010 Presented by: Douglas Fridsma, MD, PhD Acting.
_experience the commitment TM July 14, 2010 CGI RAC Region B Outreach Michigan Hospital Association Member Forum.
Security Standards under Review for esMD. Transaction Timeline An esMD transaction begins with the creation of some type of electronic content (e.g. X12.
HIT Standards Committee Clinical Operations Workgroup Report Jamie Ferguson, Chair Kaiser Permanente John Halamka, Co-chair Harvard Medical School 20 August,
EWiSACWIS Providers PAW-TAW November Provider Changes – Part I Ability to close provider records –Provider records are no longer active and inactive.
Electronic Submission of Medical Documentation (esMD) Identity Proofing Sub-Workgroup October 31, 2012.
Electronic Submission of Medical Documentation (esMD) Initiative Breakout Session Wednesday, April 11 th, :00 PM – 6:00 PM 1.
Autism (CMDE/ EDIBI) Atrezzo Provider Portal Submission Requirements INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT.
Title – NwHIN CAQH/CORE X12 support Discussion Date June
Standards Analysis Summary vMR –Pros Designed for computability Compact Wire Format Aligned with HeD Efforts –Cons Limited Vendor Adoption thus far Represents.
Electronic Submission of Medical Documentation (esMD) Sub-Workgroup October 10, 2012.
EMAS Walkthrough Registration, registration updates and consultation.
EsMD PPA Use Case 2 WG Meeting Wednesday, April 18 th, 2012.
EsMD Harmonization Mapping Analysis for X & X
Health eDecisions Use Case 2: CDS Guidance Service Strawman of Core Concepts Use Case 2 1.
1 TOWER CONSTRUCTION NOTIFICATION SYSTEM ENHANCEMENTS March 30, :00 PM Room 6-B516 of the Portals II Building 445 Twelfth Street, SW Washington,
RESEARCH AND RESOLVE Professional Claim Denials HP Provider Relations/June 2014.
Atrezzo Provider Portal Outpatient Case Creation July 2015 INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT 1.
Company Confidential Registration Management Committee RMC Auditor Workshop Charleston, SC July 2015 The OASIS Feedback Process Empowering Communication.
Communications Management: Introduction to the Basics Peter Woodward Systems Analyst Baldwin Wallace University.
Standard Unique Health Identifier for Health Care Providers April 9, th Annual HIPAA Summit Gail Kocher Highmark.
Setting Up TGO User Accounts. Creating User Accounts for Other Users If your company has other users who need to use the Active Orders system, your company’s.
Electronic Submission of Medical Documentation (esMD)
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. The Health Insurance Claim Form Chapter 20.
Atrezzo Provider Portal Inpatient Case Creation July 2015 INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT 1.
EsMD Harmonization Use Case 2: Initial Technical Approach XD* and CDA Erik Pupo.
“ Jericho / UT Austin Pilot” Privacy with Dynamic Patient Review April 30, 2013 Presented by: David Staggs, JD, CISSP Jericho Systems Corporation.
Title – NwHIN CAQH/CORE X12 support Discussion Date June
Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association. Timely Filing and Corrected Claims October.
MAPIR 5.7 Walk-Through Vermont Medicaid Electronic Health Record (EHR) Incentive Program May 25, 2016.
Standards and Interoperability Framework esMD Primer of S&I Phases, Procedures, and Functions S&I F2F Thursday, April 12 th, :00 AM.
Let Auditing Be Your Superpower
To Logon: URL: Input: Login ID (user address)
Presentation transcript:

esMD Harmonization UC2 Data Element Prioritization 8/1/2012

Overview Karen Shutt, X SME, identified esMD data elements that are not represented in the 277 Request for Information transaction set Workgroup leads reviewed and prioritized unrepresented data elements with additional input from Karen Shutt and WEDI members

eMDR Message (1/2) esMD Data Set Requirement esMD DefinitionPriority /Status Conclusions Individual Provider or Provider Organization Address Location specified for the provider receipt of additional documentation requests LowUnnecessary for electronic communications Individual Provider Prefix LowUnnecessary Payer or Payer Contractor Digital Certificate RequiredMight be able to use 277 REF segment but need additional research. Could this be included in metadata or is this something that needs to remain with the request? Payer or Payer Contractor Signature Artifact Required

eMDR Message (2/2) esMD Data Set Requirement esMD DefinitionPriority/ Status Conclusions Payer Organization vs Payer Contractor Must include the payer and recommend including the specific payer contractor. Should provide contact information for the payer contractor if one is involved. High/ Possibly covered Could use 277 PER Elements within the Payer Information loop or within the Claim Supplemental Information loop for Contractor contact information CMS - Prefer to use OIDs to represent each contractor. Commercial - Need to identify preferences Purpose of eMDR Request Type High/ Covered pending further research Limit to ASC X12 R Request Codes, with potential extensions to codify authority. Request Type Reason Text description of reason for the replacement, follow up, or termination for a prior request LowUnnecessary in structured approach

General Request Information esMD Data Set Requirement CommentsPriority/ Status Conclusions Date of Request Date the eMDR was sentLow/ Covered 277 includes a response due date and transaction date. These may be sufficient for esMD. Cover Letter Text LowUnnecessary in structured approach (pending further review of CMS requirements) Program The type of program sending the eMDR (e.g. MAC, RAC, CERT, ZPIC) High/ TBD Unnecessary if authority of requestor can be communicated via extensions to ASC X12 R Request Codes

Audit Specific Information esMD Data Set Requirement CommentsPriority/ Status Conclusions Scope or Type of Audit Pre certification, Claim Payment Documentation, Audit, Payment Recovery Medium/ Covered Covered via ASC X12 R Request Codes Unique Case Reference Identifier A case number used to track one or more related eMDRs. Serves as a unique external ID. RequiredSubmit change request to ASC X12

Claim Related Information esMD Data Set Requirement CommentsPriority/ Status Conclusions Provider Directory Address Required/ Covered Use existing support for URLs Provider Directory ID HighUse and existing ID element and research possibility of adding additional qualifier to clarify the ID Payer Identifier for the Policy holder An identifier assigned by the payer to the policy holder under which payment will be made for this beneficiary TBDCMS – Unnecessary Commercial - May be required since claims are generated in financial systems based on policy holder and the supporting documents are in clinical system based on patient. Need to be able to tie these together. Beneficiary Date of Birth TBDCMS – Unnecessary Commercial - Need to review requirements

Claim Related Information (Claim Level Detail) esMD Data Set Requirement CommentsPriority/ Status Conclusions Date Claim Received Claim could be submitted multiple times with revisions. This provides a way to differentiate between the multiple claim submissions. Medium/ Internal Discussion Need to decide if this is necessary and of value to providers. Type of Bill Covered277 includes bill type as found in ASC X12N 837, CLM05 which reflects NUBC Form Locator 4 Place of Service High/TBDSubmit to WEDI for community review and feedback Diagnosis Code(s) Code Set Used Related Group Code High/TBDSubmit to WEDI for community review and feedback

Claim Related Information (Line Level Detail) esMD Data Set Requirement CommentsPriority/ Status Conclusions Performing Provider NPI Alternate ID Alternate ID Type 277 supports NPI of Service Provider as identified in Loop 2100C, but Service Line Information does not have data element for additional or different NPI. RequiredSubmit to WEDI for community review and feedback Provider Specialty Low Line Level Diagnosis Code High/TBDSubmit to WEDI for community review and feedback

Return Method Object esMD Data Set Requirement CommentsPriority/ Status Conclusions Return Methods Code set that defines high level transport option that may be used for the return. Examples - Physical, Electronic Transaction, URI RequiredIntroduce concept to WEDI and CAQH CORE for community feedback. Conversation with X12 to follow. Electronic Service Information Required Maximum Electronic Return Size per transaction High Return Constraints Codified constraints for a specific Return Method. Examples - International Code Sets, Extended ASCII Character Sets, Language High Return Format(s) Codified formats allowed for a specific Return Method. Examples – USB drive, CDs, PDFs, UML, XHTML Required

Summary of Analysis (1/3) Covered: 1.Date of Request 2.Scope or Type of Audit 3.Type of Bill 4.Purpose of eMDR / Request Type 5.Provider Directory Address Unnecessary: 1.Individual Provider or Provider Organization Address 2.Individual Provider Prefix 3.Request Type Reason 4.Cover Letter Text 5.Provider Specialty

Summary of Analysis (2/3) Required: 1.Payer or Payer Contractor Digital Certificate 2.Payer or Payer Contractor Signature Artifact 3.Unique Case Reference Identifier 4.Performing Provider NPI / Alternate ID / Alternate ID Type 5.Return Methods 6.Electronic Service Information 7.Maximum Electronic Return Size per transaction 8.Return Constraints 9.Return Format(s)

Summary of Analysis (3/3) Further Discussion Required: 1.Payer Organization vs Payer Contractor (Commercial Payers) 2.Payer Identifier for the Policy holder (Commercial Payers) 3.Beneficiary Date of Birth (Commercial Payers) 4.Line Level Diagnosis Code 5.Provider Directory ID 6.Maximum Electronic Return Size per transaction 7.Return Constraints 8.Program

Next Steps 1.Submit Change Request to X12 for Unique Case Reference Identifier 2.Reach out to commercial payers for additional input on TBD Elements 3.Submit Required Elements to WEDI for community review and feedback 4.Submit Return Method Objects to CAQH CORE for review and feedback 5.Reach out to Claim Adjustment Status Code Maintenance Committee for guidance on extensions to R Request Codes in order to communicate authority 6.Update priorities based on input from esMD workgroup members, commercial payers, and WEDI community 7.Submit necessary change requests to X12 8.Submit necessary change requests to CAQH CORE 9.Submit necessary change requests to Claim Adjustment Status Code Maintenance Committee