HIPAA Recommendations PoC Program Update
X12 convened a group inclusive of its Licensing Partners to assess and validate the enhancements supported by the newer versions of the Health Care Claims and Payments transactions through the end of 2024. X12 is pleased to announce that this important work continues through 2025 and beyond, expanding to cover newer versions and different transactions.
The PoC group published a summary and conclusions based on its 2024 activities, and is excited to announce a new phase in this program. This next phase focuses on the latest published version of the X12 270/271 Health Care Eligibility Benefit Inquiry and Information Response, which is 008040 and soon to be updated to 008060. The PoC group’s analysis of enhancements between the 005010 and 008040 counterparts is currently underway.
The 270/271 front matter includes a wealth of important information. Requirements and guidance are provided for different business scenarios and may vary depending on the type of parties exchanging the 270/271, the line of business, and the intended purpose. X12’s Benefit Information work group emphasizes the criticalness for each organization to independenty and carefully review the changes between 005010 and any newer version.
Additional requirements to support electronic prescribing processes related to the eligibility inquiry and response are included in the newer version as well as new guidance to support the dental community.
Service Type Codes are now an external code list, rather than internal to the guide. The benefit of this change is that it allows code values to be added several times a year instead of just once annually when the TR3 is updated. These external code lists are already available on the X12 website.
Guidance from the respective CAQH CORE Operating Rules, such as base and remaining cost shares, has been incorporated into the new version of the 270/271 guide.
There are many other enhancements which the PoC participants will review and analyze with the intent of verifying the benefits of this new version are achievable, demonstrating existing processes will continue to work in the new version, and providing high-level implementation estimates as X12 has previously provided.
X12 invites you to join us in Saint Paul, MN on Thursday, June 5th during the X12 Summer 2025 Standing Meeting, for a roundtable discussion with some of the PoC participants about this exciting new direction and what to expect next.