Section title: News

X12 PoC Program Participants Validate First Series of HIPAA Recommendations

X12’s Proof of Concept program (PoC) participants are proud to announce they have verified that the first series of recommended transactions meet the first two testing categories the group defined and have validated that the respective benefits appear to be achievable.

During the summer 2022, X12 submitted the first in a series of recommendations for advancing the version of already mandated transactions and for proposing additional transactions for adoption. The first series of X12 implementation guides recommended for adoption includes:

  • 008020X323 Health Care Claim: Professional (837)
  • 008020X324 Health Care Claim: Institutional (837)
  • 008020X325 Health Care Claim: Dental (837)
  • 008020X322 Health Care Claim Payment/Advice (835)

Following this, X12 worked with its licensing partners to create a Proof of Concept program (PoC) to collaborate and validate the transactions throughout all the series of recommendations. The high-level objectives for the program include verifying that the transactions work as expected without breaking functionality that worked with the respective 005010 version, validating that the business benefits are achievable, estimating the implementation/transition costs, and identifying unforeseen obstacles related to cross-version and other dependencies.

Several months ago, the PoC participants clarified the types of testing and validating they'd complete for the recommended transaction standards as part of the program. The first two types of testing include:

  • Standard Level Validation
    Validates segments, segment order, and element attributes, verify the data types and validates syntax and compliance with X12 rules (X12.5 and X12.6).
  • Implementation Guide Validation
    Testing for implementation guide-specific requirements, such as: repeat counts; used and not used codes, elements and segments; required or intra-segment situational data elements; non-medical code sets as laid out in the implementation guide and values noted via an X12 code list.

Participants in the group represent approximately 12 companies including health plans, providers, clearinghouses, software, and service vendors. The group holds monthly checkpoint meetings with iterative work using X12's online collaboration tools and artifacts.

Over the past several months, resource constraints have been challenging due to the lack of a proposed or final rule from the federal government. Despite these obstacles, the PoC participants have confirmed that all four of the recommended transactions meet the standard and implementation guide level validations, and support cross-version interdependencies. Additionally, the high-level estimates X12 provided appear to be relatively accurate, if anything higher than the time actually incurred. 

If you have questions or feedback regarding X12’s PoC program, please complete the online feedback form and select “HIPAA Recommendations – Current” as the category.