X12 Recommendations to NCVHS

Introduction

X12 has submitted the first in a series of recommendations related to advancing the version of already adopted and mandated transactions and proposing additional transactions for adoption.

Based on industry feedback, X12 is using a phased approach for the recommendations rather than presenting the entire catalog of adopted and mandated transactions at once. Each recommendation will cover a set of logically grouped transactions and will include supporting information that will assist reviewers as they look at the functionality enhancements and other revisions.

The information presented below conveys the groupings as currently identified; however, the order of the groups shown below may not reflect the order in which X12 will submit recommendations. The timing and order of the recommendations will be based on several factors including the approval of necessary maintenance, the criticality of the functionality enhancements, and the completion of the supporting information.

The information presented on the webpage will be updated regularly as more information is available. X12 will also post updates on our social media accounts. Stay informed by following X12 at @x12standards on Twitter or #X12 on LinkedIn.

Key
† = Current mandate, updated
‡ = Recommended new mandate

Claim Submission / Remittance Advice (June 2022)

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) †

Claim Status (August 2022)

008020X329  |  Health Care Claim Status Request and Response (276/277) †

Sponsor Related (August 2022)

008020X333  |  Benefit Enrollment and Maintenance (834) †
008020X334  |  Payroll Deducted and Other Group Premium Payment for Insurance Products (820) †

Acknowledgments

Dates and Version TBD based on approval/publication

X335  |  Implementation Acknowledgment for Health Care Insurance (999) ‡
X321  |  Application Reporting for Insurance (824) ‡
X330  |  Health Care Claim Acknowledgment (277) ‡
X331  |  Health Care Claim Pending Status Information (277) ‡

Eligibility

Dates and Version TBD based on approval/publication

X332  |  Health Care Eligibility/Benefit Inquiry and Information Response (270/271) †

Health Care Services Review

Dates and Version TBD based on approval/publication

X342  |  Health Care Services Review – Request for Review and Response (278) †
X327  |  Health Care Services Review – Inquiry and Response (278) ‡
X328  |  Health Care Services Review – Notification and Acknowledgment (278) ‡

All-Payer Claim Database Related

Dates and Version TBD based on approval/publication

X298  |  Post-adjudicated Claims Data Reporting: Professional (837) ‡
X299  |  Post-adjudicated Claims Data Reporting: Institutional (837) ‡
X300  |  Post-adjudicated Claims Data Reporting: Dental (837) ‡
X326  |  Health Care Service: Data Reporting (837) ‡
X364  |  Data Reporting Acknowledgment (277) ‡
X318  |  Plan Member Reporting (834) ‡

Health Care Claim Attachments

A recommendation will be moved forward once the pending Final Rule mandating version 006020 is issued.

X313  |  Health Care Claim Request for Additional Information (277) ‡
X314  |  Additional Information to Support a Health Care Claim or Encounter (275) ‡
X316  |  Additional Information to Support a Health Care Services Review (275) ‡