In reviewing the technical specification for this payer there is a requirement for the patient's race in 2010BA/CA-DMG05. An email from the payer states they are not considered a HIPAA covered entity: "THCIC is not a covered entity under HIPAA, therefore is not required to comply with HIPAA standard transactions. Health and Safety Code, §108.009(h) requires that we…collect the data in submission formats…developed by [ANSI] or its successor or other nationally accepted standardized forms. Section 108.009(k) also requires that we (DSHS) collect the racial and ethnic background of patients, although this is not part of the HIPAA compliant ANSI ASC X12N 837 Version 5010…Implementation Guides. Our contractor’s (System13, Inc.) system will allow you to submit the data without the race and ethnicity codes…The collection of [data] is required by Texas law and failure to report such information could result in an administrative action against the…facility." Is this a valid request by the payer?
As you pointed out, the 2010BA/CA-DMG05 Composite Race or Ethnicity Information is Not Used in the Professional version X005010221A1 TR3. Therefore, any requirement that it be used is not compliant with the TR3. Whether an entity is or is not mandated under HIPAA or any other State or Federal legislative mandate is irrelevant to the compliant usage of any X12 published TR3. Related to your question regarding requiring that this data be sent: "Per the ASC X12 Intellectual Property Use (see http://store.x12.org/store/ip-use), inclusion of a requirement as described violates the Must Not provisions: 'Contradict, countermand or duplicate any requirement of the associated TR3' and Add, modify or delete any requirements, including loop, segment or element names, notes or rules, examples, appendix, or code list subsets from Section 2'."
The 2300 K3 – File Information Situational usage rules and TR3 notes read:
Situational Rule: Required when ALL of the following conditions are met:
• A regulatory agency concludes it must use the K3 to meet an emergency legislative requirement;
• The administering regulatory agency or other state organization has completed each one of the following steps: contacted the X12N workgroup, requested a review of the K3 data requirement to ensure there is not an existing method within the implementation guide to meet this requirement
• X12N determines that there is no method to meet the requirement. If not required by this implementation guide, do not send.
TR3 Notes:
At
the time of publication of this implementation, K3 segments have no specific use. The K3 segment is expected to be used only when necessary to meet the unexpected data requirement of a legislative authority. Before this segment can be used :
The X12N Health Care Claim workgroup must conclude there is no other available option in the implementation guide to meet the emergency legislative requirement.
1. The requestor must submit a proposal for approval accompanied by the relevant business documentation to the X12N Health Care Claim workgroup chairs and receive approval for the request. Upon review of the request, X12N will issue an approval or denial decision to the requesting entity. Approved usage(s) of the K3 segment will be reviewed by the X12N Health Care Claim workgroup to develop a permanent change to include the business case in future transaction implementations.
2. Only when all of the requirements above have been met, may the regulatory agency require the temporary use of the K3 segment.
3. X12N will submit the necessary data maintenance and refer the request to the appropriate data content committee(s).
If a regulatory agency concludes it has a legislative requirement not met elsewhere in the TR3 the administering agency can request a review by the appropriate X12N Work Group for approval to use the K3 segment to meet this need