CMS Publishes New Proposed Rule for Electronic Healthcare Claims Attachments

On September 23, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register a proposed rule adopting standards for electronic healthcare claims attachments. Healthcare claims attachments are documents and information, such as physician notes and medical images, required by health plans to adjudicate certain claims. The proposed rule, mandated by HIPAA, adopts two new X12 transaction standards: a Health Level 7 (HL7) messaging standard to carry clinical information in the response transaction and HL7 specifications for the content or “questions” that may be asked in each of the six attachment types. The publication of this proposed rule was a landmark event for the Accredited Standards Committee (ASC) X12 and HL7, whose members have worked collaboratively on these complex standards for electronic claims attachments since 1997. Both the ASC X12 Insurance Implementation Guides and the HL7 specifications can be downloaded free of charge at www.wpc-edi.com.

This proposed rule also adopts the Logical Observation Identifiers Names and Codes (LOINC) as a new HIPAA code set to be used to identify the questions and answers (attachment information). The standards allow for the transmission of structured or coded data, as well as images and text. The proposed rule solicits comments from the affected industries on several key issues, including the adoption of LOINC and its use for the HIPAA transactions, the appropriateness of the six proposed attachment types, business requirements for attachments that would accompany the original claim (unsolicited attachments), and the cost-benefit implications of adopting this transaction set.

The public comment period is open until November 22. For information on submitting comment and to read the full text of the proposed rule for Claims Attachments: http://www.hipaadvisory.com/regs/regs_in_PDF/claims_attach.pdf