1. 1 So You Want to Make a Change — Changing X12 Materials — So You Want to Make a Change — Changing X12 Materials — May, 2005

2. 2 So You Want to Make a Change Topics Products, Processes, and Forms Selected Processes Details Timings and Schedules More Details

3. 3 X12 Products Standards –Transactions  X12 Syntax  EDIFACT Syntax  XML Syntax –Communications and Controls Code Sets –Internal code sets –Sources for external code lists continued on next slide

4. 4 X12 Products Technical Reports –Type 1 – Tutorial [for one standard] –Type 2 – Reference Model [cross-standards] –Type 3 – Implementation Guide (IG) Adopted for HIPAA Not Adopted for HIPAA Interpretations –Transaction Standards –Implementation Guides [X12N/TG2 only]

5. 5 Key Non-X12 Products External Code Lists; e.g., –ICD-9 – NDC – Reason Codes –CPT-4 – CDT – Remark Codes –HCPCS – DRG – Revenue Codes –NPlanID – NPI – Employer ID –NAIC – UPC – ‘Bank’ Numbers –LOINC – Taxonomy – Error Codes –ZIP Codes – States and Outlying Areas Codes –Countries, Currencies and Funds Codes HIPAA Regulations

6. 6 Key Non-X12 Products External Code Lists; e.g., –ICD-9 – NDC – Reason Codes –CPT-4 – CDT – Remark Codes –HCPCS – DRG – Revenue Codes –NPlanID – NPI – Employer ID –NAIC – UPC – ‘Bank’ Numbers –LOINC – Taxonomy – Error Codes –ZIP Codes – States and Outlying Areas Codes –Countries, Currencies and Funds Codes Sunday, noonSunday, 1pm Regular, non-X12, Code Committee Meetings that precede each X12 Meeting

7. 7 X12 Change Paradigm Once X12 documents are published, they are never modified All changes are incorporated into follow-on documents –New standards versions; including complete lists of all internal code sets values and sources for external codes lists –New Implementation Guides (IG), IG Addenda, and IG Errata [X12N only] –New Technical Reports (TR1, TR2, TR3) Differences from predecessor documents are noted

8. 8 Most Common X12 Processes Data Maintenance (DM) Code Maintenance Request (CMR) X12N IG and TR3 Development HIPAA Change Request (CR) Request for Interpretation – Implementation Guide (HIR) – Transaction Standard (RFI)

9. 9 Primary X12 Forms X12 Project Proposal –New X12 Standard –Revised X12 Standard continued on next slide

10. 10 Primary X12 Forms X12 Work Request –Revised X12 Standard –New Technical Report –Data Maintenance for a new or revised X12 Standard; but most new or revised code values may use the online CMR form online version also available continued on next slide

11. 11 Primary X12 Forms X12 Code Maintenance Request (CMR) –New or revised X12 code values; except those in envelope segments ISA, IEA, GS, and GE –Online form only; available on the X12 web site http://x12.org/x12org/X12Standards/CMR/SubmitterInformation.cfm continued on next slide

12. 12 Primary X12 Forms X12 Transmittal Form Records 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

13. 13 Primary X12 Forms X12N Implementation Guide Project Proposal –New Implementation Guide (IG) [which may or may not become a new Type 3 Technical Report (TR3) ] –Revised IG; i.e., IG Addenda –IG Errata continued on next slide

14. 14 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 covered ASC X12N/TG2 Interpretations Portal Register Search Login Help continued on next slide

15. 15 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.” – RFI’s should be sent to: Chair, Accredited Standards Committee X12 c / o Data Interchange Standards Association 7600 Leesburg Pike, Suite 430 Falls Church, Virginia 22043 Attn: Request for X12 Interpretation

16. 16 So You Want to Make a Change Topics Products, Processes, and Forms Selected Processes Details Changing an existing transaction standard Adding or changing an X12 code value Requesting changes to an IG or TR3 Creating a new IG or TR3 Timings and Schedules More Details

17. 17 Changing an Existing Transaction Standard Use Data Maintenance (DM) process for –Revised transaction standards –New or revised segments –New or revised data elements –New or revised X12 code values † –New or revised non-X12 code sources ‡ –New or revised control standards † Most new or revised X12 code values may be processed more rapidly using the online CMR process ‡ New 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

18. 18 Changing an Existing Transaction Standard Data 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

19. 19 Changing an Existing Transaction Standard Data Maintenance (DM) Waypoints in X12N  Work Request Form Process  Secretariat – DISA – functions: –Obtains X12N Chair or Vice-Chair signature on Work Request Form –Copies signed Work Request Form –Submits original Work Request Form to DISA data base Update Center –Reviews DM in DISA data base for accuracy –Assigns and records DM number –Prepares for and runs DM Ballot Process http://x12.org/x12org/Subcommittees/PP/ASCPROC/sd4-published-1997.pdf SIDEBARSIDEBAR

20. 20 Adding or Changing an X12 Code Value Use Code Maintenance Request (CMR) process for –New or revised X12 code values Notes: 1. DM process may always be used if desired; it’s 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

21. 21 Adding or Changing an X12 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

22. 22 Requesting Changes to an IG or TR3 A.If only an IG – use collegial process (i.e., make change suggestions known to responsible / authoring work groups) and/or B.If IG is also a TR3 – use Work Request Form process and/or C.If IG or TR3 is adopted under HIPAA – use Designated Standards Maintenance Organizations’ (DSMO) online Change Request System (CRS) www.hipaa-dsmo.org/crs

23. 23 Requesting Changes to a HIPAA IG or TR3 DSMO 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 continued on next slide

24. 24 Requesting Changes to a HIPAA IG or TR3 DSMO 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 continued on next slide

25. 25 Requesting Changes to a HIPAA IG or TR3 DSMO 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 IG’s responding to changes requested  Participate at X12 Trimester Meeting Informational Forums for IG’s responding to changes requested

26. 26 Creating a New IG or TR3 Use X12N IG Handbook Process for –New Insurance Subcommittee (X12N) Implementation Guide (IG) or new Type 3 Technical Report (TR3) –Revised X12N IG – Addenda –Errata to an X12N IG Five phases

27. 27 Creating a New IG or TR3 IG 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/registry continued on next slide

28. 28 Creating a New IG or TR3 IG 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

29. 29 Creating a New IG or TR3 IG 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} continued on next slide

30. 30 Creating a New IG or TR3 IG 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 continued on next slide

31. 31 Creating a New IG or TR3 IG 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

32. 32 So You Want to Make a Change Topics Products, Processes, and Forms Selected Processes Details Timings and Schedules More Details

33. 33 Rule-of-Thumb Timings Approximate change processing timing from Start of Work through Publication Process X12 Flow Time CMR 8 – 12 months DM 1 or more years IG 1½ – 2 years TR3 2 – 2½ years Patient persistent participation is paramount.

34. 34 Rule-of-Thumb Timings If DSMO Change Request System (CRS) Process used … add an additional 4 months to two years If HIPAA adoption required … add an indeterminate amount of time for –DSMO Steering Committee approval –National Committee on Vital and Health Statistics (NCVHS) hearings and recommendation –Notice of Proposed Rule Making (NPRM) preparation and public comment –Final Rule preparation –180 day to three year compliance period following nominal 60 day Congressional Review period

35. 35 Publication Schedules X12 Transaction and Code Set Standards Fixed, unvarying schedule Three time-sequences each year Materials published –Primary Release  January –Sub-releases  March and July http://x12.org/x12org/subcommittees/dev/PDF/X12RELEASESCHED.pdf continued on next slide

36. 36 Publication Schedules Insurance Subcommittee (X12N) Implementation Guides (IG) and Type 3 Technical Reports (TR3) –Property and Casualty Task Group (X12N/TG1) As needed –Healthcare Task Group (X12N/TG2) Presumed virtually all need ongoing modification Updated approximately every two years Rotating, staggered schedule [two dozen documents presently slotted into five time-sequences] http://x12.org/x12org/subcommittees/X12N/N0200_X12N005010_TR3.pd f

37. 37 So You Want to Make a Change Topics Products, Processes, and Forms Selected Processes Details Timings and Schedules More Details

38. 38 More Details X12 Standing Document 2 (SD2): Operations Manual –Development and Maintenance Procedures for Standards, Interpretations, Guidelines and Technical Reports –http://x12.org/x12org/subcommittees/x12j/J0000_sd2.pdf Healthcare 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 standards –http://x12.org/x12org/subcommittees/X12N/N0200_ASC_X12NTG2_Handbook.pdf continued on next slide

39. 39 More Details Property and Casualty Task Group Handbook –http://x12.org/x12org/subcommittees/X12N/N0100_NTG1Handbook_jun02.PDF X12N Implementation Guide Handbook –Policies, Procedures, and Conventions for IG / TR3 Development, Review, and Distribution –One 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

40. 40 More Details Designated Standards Maintenance Organizations (DSMO) Memorandum of Understanding (MOU) –Joint document by X12, NCPDP, HL7, NUBC, NUCC, and DeCC –Outlines cooperative framework for maintenance of HIPAA transactions –http://hipaa-dsmo.org/mou.pdf X12 HIPAA Change Request Processing Workflow –Flow charts derived from DSMO MOU –Expanded and personalized for X12N –http://x12.org/x12org/subcommittees/X12N/N0303_X12_HIPAA_Workflow.pdf continued on next slide

41. 41 More Details HIPAA Transactions – The Next TR3’s –The follow-on to this presentation –Contact this presenter or X12N/TG3/WG3, HIPAA Implementation and Coordination, to arrange HIPAA Transactions – The Next TR3’s TOPICS Materials used in HIPAA TCS Processes for Creating Materials Current Schedules Some Unanswered Questions

42. Questions?Comments? Smart Remarks? 42 So You Want to Make a Change — Changing X12 Materials —

43. 43 So You Want to Make a Change — Changing X12 Materials — So You Want to Make a Change — Changing X12 Materials — Prepared and Presented by David A. Feinberg, C.D.P. Insurance Education Task Group ( X12N/TG11)

44. 44 So You Want to Make a Change — Changing X12 Materials — Contacting the author David A. Feinberg, C.D.P. Teacher, Insurance Education (X12N/TG11) Co-Chair, HIPAA Implementation and Coordination (X12N/TG3/WG3) Rensis Corporation 206-617-1717 DAFeinberg@computer.org

45. 45 Insurance Education (X12N/TG11) Training Catalog Insurance Subcommittee (X12N) Introduction Insurance Subcommittee (X12N) Charter Healthcare Insurance Task Group (X12N/TG2) Introduction Codes at X12 Changing X12 Materials HIPAA and X12 [compliments of X12N/TG3/WG3] Extensible Markup Language (XML) Introduction X12’s Context Inspired Component Architecture (CICA) Overview Robert’s Rules of Order as of February, 2005