X12 Member Announcement: Recommendations to NCVHS - Set 2

Greetings X12 Member Representatives,

We wanted you to be the first to know the next set of recommendations for advancing the version of already mandated transactions will be released next week. The implementation guides in this set include the following.

• 008030X329 Health Care Claim Status Request and Response (276/277)
• 008030X333 Benefit Enrollment and Maintenance (834)
• 008030X334 Payroll Deducted and Other Group Premium Payment for Insurance Products (820)

As with the first set of recommendations, we are recommending both the 008030 EDI Standard representation (the implementation guide) and its XML representation be named as permitted syntaxes. Recognizing the challenges of a lengthy Federal Rule-making process that doesn't always operate at an expected cadence and our continuously evolving standards, we are recommending that preliminary review and analysis be conducted on the 008030 versions of these guides. When the CMS National Standards Group is ready to issue a Notice of Proposed Rule Making (NPRM) we are asking that they work with us to identify the most recently published version of the implementation guides and name those versions in the NPRM. This will allow for revisions based on lessons learned during the pilot, improvements for clarity and consistency, and feedback from organizations reviewing the implementation guides during the NCVHS process.

The enhancements shown below and called out in the recommendations were identified by X12N|TGB workgroups as we closed out the BRTS process and moved to the ARC-MR process.

008030X329 Health Care Claim Status Request and Response 276/277

1. Reduces ambiguity throughout the implementation guide
2. Increases data synchronization with the claim transactions
3. Adds the ability to report the status of predeterminations for medical and dental care
4. Supports a property and casualty claim number when one applies
5. Increases the number of service line procedure modifiers supported
6. Supports tooth-level information on dental claim status responses
7. Enhances the instructions for real-time vs batch processing
8. Supports one information source and one information receiver per transaction
9. Enhances the linkage between a 276 Request and a 277 Response
10. Supports claim status when a claim has been transferred to another entity for processing

008030X333 Benefit Enrollment and Maintenance 834

1. Reduces ambiguity throughout the implementation guide
2. Adds Medicare-specific coverage begin and termination dates
3. Supports the tracking of date/time for online applications
4. Supports the Individual Taxpayer's Identification (ITIN)
5. Enhances gender reporting
   *additional gender reporting enhancements are pending based on the cross-SDO Gender Harmony Project's recommendations
6. Supports use of the Class of Race or Ethnicity from the CDC
7. Supports reporting of pregnancy-related dates
8. Supports tax advantage account information
9. Enhances maintenance reason codes related to health coverage

008030X334 Payroll Deducted and Other Group Premium Payment for Insurance 820

1. Reduces ambiguity throughout the implementation guide
2. Enhances consistency between implementation guides
3. Supports adjustments to a prior payment
4. Enhances member-level information
5. Adds member-level coverage information
6. Supports reassociation of premium payments and enrollment transactions

The X12 Board, officers, and staff appreciate the diligent and dedicated work the X12 member representatives invested as we worked to add functionality, clarity, and consistency to our already effective, efficient, and stable transactions.

Sincerely,

Steph, Gary, Tara, and Cathy