X12 Member Announcement - Recommendation to NCVHS
Good afternoon,
We wanted to let our member representatives know that X12 submitted its official recommendation for advancing the version of already mandated transactions this week. We also notified the other organizations named as Designated Standards Maintenance Organizations (DSMOs) in the HIPAA regulations and the Workgroup for Electronic Data Interchange (WEDI), which was named as an advisory body of the recommendation.
We recommend advancing the implementation guides listed below to version 008060.
- 008060X322 Health Care Claim Payment/Advice (835)
- 008060X323 Health Care Claim: Professional (837)
- 008060X324 Health Care Claim: Institutional (837)
- 008060X325 Health Care Claim: Dental (837)
- 008060X329 Health Care Claim Status Request and Response (276/277)
- 008060X332 Health Care Eligibility/Benefit Inquiry and Information Response (270/271)
- 008060X333 Benefit Enrollment and Maintenance (834)
- 008060X334 Payroll Deducted and Other Group Premium Payment for Insurance Products (820)
- 008060X342 Health Care Services Review – Request for Review and Response (278)
- 008060X340 Health Care Claim Request for Additional Information (277)
- 008060X341 Additional Information to Support a Health Care Claim or Encounter (275)
- 008060X343 Additional Information to Support a Health Care Services Review (275)
We also recommended that the corresponding derived schema definitions that support the direct representation of the transaction in XML syntax be named as a permitted syntax. As you know, these representations are mechanically generated from the same metadata as the implementation guides, ensuring no discrepancies between the syntaxes.
We reiterated that revision reporting is not a one-size-fits-all activity and that implementers approach the analysis of new versions from various perspectives. We noted it is vital for implementers to evaluate enhancements and revisions in the context of related and complementary information in the transaction, and through the lens of their organization's proprietary software solutions. Keeping all this in mind, we committed to providing several change summary options, including:
- A mechanical comparison, posted on our website, that includes all changes between a 005010 implementation guide and its 008060 counterpart.
- A list, posted on our website, of high-value revisions calling out enhancements and why they are valuable to the health care industry stakeholders, including consumers.
- A markup posted on our website of the transaction set listing for each implementation guide, identifying segments that were revised, so implementers have a starting point for their analysis.
- A summary of the mandated Operating Rules published by CAQH CORE that were integrated into the corresponding 008060 X12 implementation guide, including explaining the reasoning for any that were not integrated.
As we discussed in the General Session of the Fall 2025 standing meeting, our Education, Information, and Messaging initiative will kick off in 2026 with a series of live and on-demand webinars to assist implementers with their assessments of the updated implementation instructions in the 008060 versions. More information about this exciting initiative and how you can get involved is coming soon.
The X12 Board, officers, and staff appreciate your unflagging commitment, exceptional contributions, and tireless effort that brought us to the milestone of this recommendation to make these enhanced versions of our already effective, efficient, and stable transactions available to healthcare stakeholders. We are also confident that X12 member representatives will work with their organizations to ensure support for these upgrades is provided at various stages of the Federal Rulemaking process.
Thank you again for the expertise and sustained enthusiasm you bring to our collaboration table.
Sincerely,
Steph Fetzer, Board Chair
Michelle Barry, ASC Chair
Tara Rose, X12N Chair
Cathy Sheppard, CEO
More information is available at X12.org/news-and-events/x12-recommendations-to-ncvhs.