I agree with Chris Stahleckers's description of the below process to
address needs that may cross SDO lines. As Chris S. suggests, we have
created this process to meet this need, will use it when needed to ensure
the needs of industry are met in the best way possible. Certainly a
collaborative effort is virtually always a better solution.
However, the vision industry may find the HIPAA implementation problem may
not be as complicated or need the response level our emails have suggested.
Chris Feahr has suggested that a small group of the vision industry
constituents meet at an upcoming vision conference to better define the
issue(s), which I believe is the appropriate next step. Subsequent steps
can then be formulated, subject to the findings of that meeting. We may
find the HIPAA implementation problem is a code set deficiency problem that
can be addressed using a simpler process. If the problem(s) go beyond an
existing code set deficiency, we can and should use the procedure Chris S.
has suggested. Accordingly, I support the September vision meeting to
better define the problem before we go to far with a solution.
Thanks -- Bruce
"Christine L.
Stahlecker" To: "Larry Watkins"
<clstahlecker@h <[EMAIL PROTECTED]>, "Ward, Maria"
cs-is.com> <[EMAIL PROTECTED]>, "Christopher J. Feahr,
OD"
<[EMAIL PROTECTED]>, <[EMAIL PROTECTED]>,
"Zon
07/25/2001 Owen" <[EMAIL PROTECTED]>
09:10 AM cc: "Margaret Weiker"
Please respond <[EMAIL PROTECTED]>, "Cabral, Mike"
to "Christine <[EMAIL PROTECTED]>, "Ken Wood"
L. Stahlecker" <[EMAIL PROTECTED]>,
<[EMAIL PROTECTED]>,
<[EMAIL PROTECTED]>,
<[EMAIL PROTECTED]>, "David Moertel"
<[EMAIL PROTECTED]>, "Chuck Meyer"
<[EMAIL PROTECTED]>
Subject: Re: Specifications for Vision
Devices
To All,
Actually the structure does exist but it has not been used recently and I
agree that it should be re-initiated and formalized in terms of a working
procol, not an MOU, between X12N and HL7 (and NCPDP if they so desire).
The 'structure' as described below had a working protocol, regular meetings
and
it's last deliverable was to identify the migration of Home Health
information out of the claim and into an attachment. This HH work
'sanctioned' by X12N, in addition to other industry identified attachments,
is
currently in progress within the HL7 Attachment SIG. There is a special
interim meeting September 10-12 in Baltimore, so as not to conflict with
the
October X12 meeting, should anyone be interested in attending.
As Maria points out, a working team was established that consisted of
selected representatives (usually 1 of the co-chairs) of the Claim, Claim
Attachment, and Claim Status (because of the request for additional
information) TG2 workgroups as well as the TG3 WG4 Modeling group. It is
important to note that the HL7 interests were represented in this group
because the individuals representing the Claim Attachment WG and Claim
Status WG were co-chairs of the HL7 Claim Attachment SIG. Additionally, a
TG3 chair is an active leader at HL7 too. So the structure was
established,
even if not 'chartered' for Vision per-se. This group clearly intended to
identify where data would live, in a claim or in an attachment and started
with data in the claim that would migrate to the attachment. The method of
coordinating data transition was also defined and that was to use future
releases
of Implementation Guides (industry expects them annually) to align the
claim
and
the attachment. Data that has moved will be labled an 'not used' in the
claim and
its location/definition added to the attachment IGs.
It seems a bit illogical to continue to add data to the claim without
considering first
whether or not it makes more sense to define it as an attachment and if so,
have to move it later. I'd suggest we work toward understanding the
business
scenarios surrounding Vision data, evaluate the options and then make a
recommendation based on 'best-fit'.
Chris
----- Original Message -----
From: Larry Watkins <[EMAIL PROTECTED]>
To: Ward, Maria <[EMAIL PROTECTED]>; Christopher J. Feahr, OD
<[EMAIL PROTECTED]>; Christine L. Stahlecker <[EMAIL PROTECTED]>;
<[EMAIL PROTECTED]>; Zon Owen <[EMAIL PROTECTED]>
Cc: Margaret Weiker <[EMAIL PROTECTED]>; Cabral, Mike
<[EMAIL PROTECTED]>; Ken Wood <[EMAIL PROTECTED]>;
<[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; David
Moertel <[EMAIL PROTECTED]>; Chuck Meyer <[EMAIL PROTECTED]>
Sent: Tuesday, July 24, 2001 8:57 AM
Subject: RE: Specifications for Vision Devices
> Maria -- Well said. Problem is, there's no structure for any of this
today,
> and the data/business modeling needs to occur. I'd just as soon not get
a
> bunch of Vision folks at the X12 meeting if this is not where the core
> discussion/work is going to occur. How can we make that determination
> before lots of people are invited to the X12 meeting?
>
> Larry
>
>
> -----Original Message-----
> From: Ward, Maria [mailto:[EMAIL PROTECTED]]
> Sent: Tuesday, July 24, 2001 8:52 AM
> To: Larry Watkins; Christopher J. Feahr, OD; Christine L. Stahlecker;
> [EMAIL PROTECTED]; Zon Owen
> Cc: Ward, Maria; Margaret Weiker; Cabral, Mike; Ken Wood;
> [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; David
> Moertel; Chuck Meyer
> Subject: RE: Specifications for Vision Devices
>
>
> All
>
> I too have had e-mail difficulties and am trying to recover... sorry for
the
> delayed response.
>
> I think Chris Stahlecker makes a very good point about this (and other)
> issues regarding development of new standards/implementation guides/
> whatever to accommodate needs brought forward by our industry. We can't
> assume that this is an issue for X12 (data modeling or otherwise) - I
think
> that's the point Chris was trying to make (right???) No question that
> considering the data needs in the context of the model is the right
> approach. Are we sure it's the right SDO and the right model? Does X12N
> know whether any work related to this specific need has already been
> addressed in HL7 or NCPDP?
>
> It may be that it is not yet a "DSMO" issue because it doesn't deal with
the
> content of existing named implementation guides but the spirit of what
Chris
> was trying to convey is that it's the SDO's involved in DSMO that should
be
> talking together about where this data should "live," not just assume
that
> it fits in the X12 data model somewhere. Unless X12 has a process built
in
> to say..." this is information that belongs in the attachment" as part of
> its evaluation process (not just me or someone else bringing it up) Maybe
so
> and it's just a matter of educating the rest of the world on what that
> process is.
>
> I think we need to consider how to discuss this across groups. In fact,
we
> think this communication is an important enough issue in HL7 that we're
> going to be addressing the issue of how the attachment SIG "formally"
works
> with X12N on these things to be sure the best solution is offered.
>
> You all remember the work of Bob Davis / Dave Moertel / Jan and the rest
of
> us a few years ago re: "what is a claim vs. what is an attachment" -
maybe
> that's something to revisit? We have to remember that going forward
we'll
> have increased needs for data that could be in the claim or the
attachment
> (depending on who you ask ) and we have to work together to address that.
> Even though the attachment NPRM isn't out yet we should be doing our
> analysis based on the fact that we will have the X12/HL7 standard for
> attachments and be mindful that this may be the answer to some of today's
> data needs. Lets consider the bigger picture.
>
> Lets not to do this development with blinders on and realize we may have
had
> other / better options. Speaking on behalf of the HL7 attachment SIG,
I'd
> request that any discussion in X12N on this and other items that may well
be
> candidates for attachments include HL7 representation. How can we put
> some kind of framework around this?
>
> Maria
>
>
>
>
>
>
>
> -----Original Message-----
> From: Larry Watkins [mailto:[EMAIL PROTECTED]]
> Sent: Tuesday, July 24, 2001 4:58 AM
> To: Christopher J. Feahr, OD; Christine L. Stahlecker;
> [EMAIL PROTECTED]; Zon Owen
> Cc: Maria Ward; Margaret Weiker; Cabral, Mike; Ken Wood;
> [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; David
> Moertel; Chuck Meyer
> Subject: RE: Specifications for Vision Devices
>
>
> The DSMO question Chris Stahlecker raises is a good one. I tend to agree
> with Chris Feahr on this one, though. Data and Business modeling need to
> occur within a consensus process before we can really help the other data
> content organizations understand what is being proposed as a potential
> standard. Clearly, the DSMO's do not have a process in place for this
type
> of modeling. I will work to encourage that the X12N type of modeling
> process occur first in these situations -- it will certainly lead to a
> better understanding of the issues and potential solutions BEFORE debate
> starts on how these needs fit into current data content structures. Even
if
> a new standard is found to be unnecessary (not likely in this case), the
> data modeling thought process will have been a productive effort.
>
> My biggest concern in all of this was also raised by Kepa Z. That is the
> ongoing problem of getting all sides of the transactions at the table --
> providers, payers, and vendors/clearinghouses. Anything that can be done
to
> get a good representation at the X12 meeting will be helpful in making
for
> productive work. What is the likelihood of getting the "right" folks to
the
> table in Miami?
>
> Regards,
> Larry
>
>
> -----Original Message-----
> From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]]
> Sent: Monday, July 23, 2001 9:19 PM
> To: Christine L. Stahlecker; [EMAIL PROTECTED]; Zon Owen
> Cc: Maria Ward; Margaret Weiker; Cabral, Mike; Ken Wood;
> [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
> Subject: Re: Specifications for Vision Devices
>
>
> Christine,
> Thank you for your comments. I did actually post a DSMO change request
on
> 4-3-01 (#437) about a need for a product code-set. But the broad nature
of
> this "problem" seems out of proportion to what the "DSMO Change Request"
> system was intended to handle. Regardless of how we choose to package
all
> of this, it does seem clear that we have to codify patient measurements
> relating to optical "prescriptions" and create a more specific coding
> structure for the products used in treatment.
>
> Where it starts to become fuzzy for me is which DSMO should be our
official
> interface with DHHS. Whether it's X12 or NCPDP, the domain expertise,
the
> articulation of the problems, and the consideration of the impact of
> various possible solutions would still seem to be something that the
Vision
> care industry will have to supply. There really aren't many people in
our
> industry who understand both the domain issues and the standards and data
> modeling issues well enough to even sit on an X12 or NCPDP committee...
and
> those few people may or may not not wish to volunteer. This is the basis
> for my proposal that the vision industry create it's own permanent
> industry-wide standards council (e.g., Vision Data Standards Council)
with
> a permanent staff that is able to actively *extract* the relevant
> information from providers and payors (essentially by interviewing them
and
> explaining proposals in plain english) and then organize it for
> presentation to ANSI at the trimester meetings. Until this entity
receives
> ANSI accreditation, it seems that it could work closely with X12 (or
NCPDP)
> to make the appropriate recommendations to HHS for the more urgent HIPAA
> issues.
>
> The smallness of most payor, provider, and software developer entities in
> Vision combined with the extraordinary complexity of the data seems to
make
> the conventional (volunteer-driven) standards development paradigm not
only
> inappropriate, but unlikely to even happen... no matter how much HHS
yells
> at our industry. Only one or two payors are large and sophisticated
enough
> to send people to an X12-type workgroup. The provider community is
almost
> entirely unable to represent its own interests without a
provider-oriented
> standards council. Manufacturers, who DO have the IT expertise are even
> further removed from the doctors' business problems and do not regard
HIPAA
> as something that even pertains to them... which in many cases is true.
>
> Thanks again to everyone who have contributed to the solution of this
> challenging set of problems.
>
> Regards,
> Chris Feahr
>
>
> At 12:29 PM 7/23/01 -0400, Christine L. Stahlecker wrote:
> >To All,
> >my apologies for being silent until now - I was working through some
email
> >difficulties.
> >
> >I agree that we need to work through an approach to this.
> >My inclination would be that vision would be treated as an attachment
and
> >therefore
> >addressed by the HL7 Attachment SIG.
> >However, since we all tend to gravitate toward different solutions, I
agree
> >with Larry's
> >suggestion to include the X12N modeling group but also ask the question
> >about the need to submit this request to DSMO...?
> >I would NOT agree that the decision on a solution would remain within
X12N
> >only.
> >I think that both HL7 and NCPDP need to be included so wherever the
> >conversations occur,
> >we need to be sure that those interests are represented. It seems that
> DSMO
> >is the
> >'official' point of entry for this request - would any
> isagree? -apologies
> >if it has been
> >submitted there - I didn't see it.
> >
> >Chris
> >
> >
> >----- Original Message -----
> >From: Christopher J. Feahr, OD <[EMAIL PROTECTED]>
> >To: Zon Owen <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>
> >Cc: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>;
> ><[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; Ken Wood
> ><[EMAIL PROTECTED]>
> >Sent: Saturday, July 21, 2001 10:52 PM
> >Subject: Re: Specifications for Vision Devices
> >
> >
> > > Wow!... this sounds great. Thanks, Zon.
> > >
> > > PS1: Regarding NCPDP, I made the suggestion a couple months ago that
we
> > > create a Vision workgroup and the NCPDP board formally declined. I
> >believe
> > > that the recommendation to me was to be sure that I had exhausted all
> the
> > > avenues available to us in X12. My thinking was essentially that
while
> > > nothing seemed to fit "off the rack" in either standards
organization,
> > > there seemed to be a better conceptual fit or at least a similarity
> >between
> > > the products in vision and those in retail pharm. Either way, I
figured
> > > we'd be starting at square #1 and winding up with a fairly unique
> > > standard. The fact that Vision combines such strong "regular doctor"
> > > features alongside all these "medical device" and "retail"
attributes,
> was
> > > probably going to make us an Ugly Duckling no matter where we tried
to
> > > wedge ourselves in. There is also the fact that many times a
mainstream
> > > insurance company is functioning as the "real" payor and using one of
> the
> > > specialized vision carriers to manage the products and the optometric
> > > services. I don't know if these companies would rather deal with
Vision
> > > benefit plan managers as pseudo-drug plans via a special version of
the
> > > NCPDP spec. or whether they'd prefer a special vision-flavor of X12.
> At
> > > any rate, the official answer from NCPDP is "no", but it was
recommended
> > > that I take the matter up with Margaret Weiker if I felt strongly
that
> we
> > > belonged in NCPDP. If we have a home in X12, then I'm happy.
> Therefore,
> >I
> > > presume the issue is moot.
> > >
> > > PS2: Regarding a practical way to post the models I have now... This
> work
> > > exists in its native form in a program called ER Studio
> > > (www.embarcadero.com) and I am able to create reports from it (both
in
> >.rtf
> > > document and an easily navigated html frameset) that list all the
> >entities,
> > > attributes, and relationships. A model diagram is also possible but
> it's
> > > rather large and not really that helpful to look at. Finally, I can
> >create
> > > an MS SQL7 database structure from it that preserves all of the
> > > relationships of the logical model.
> > >
> > > -Chris
> > >
> > > At 12:45 PM 7/21/01 -1000, Zon Owen wrote:
> > > >Chris,
> > > >
> > > >Per our earlier exchange, I am already planning on putting this on
the
> > > >X12N/TG3/WG2 (Healthcare Modeling) agenda for October, but you will
> >probably
> > > >want to discuss this at the Task Group 3 level too.
> > > >
> > > >Dave / Chuck: Do you see any problem getting this on the X12N/TG3
> agenda
> > > >either Sunday afternoon or as early as possible otherwise? I am
> >"planning"
> > > >to propose a X12N/TG3/WG2 agenda in another week or two, and this
would
> >go
> > > >on it. But X12N/TG3/WG4 would also be interested, as would
> X12N/TG2/WG2
> >and
> > > >the attachments specialists. (We may need an auditorium for this
one,
> >too,
> > > >once we get our bearings!).
> > > >
> > > >Monique / Fred / Kathleen: Do you have any input on this? Does
anyone
> >else
> > > >in X12N/TG3?
> > > >
> > > > - Zon Owen -
> > > >(808)597-8493
> > > >
> > > >PS1: I would still like to know the status of your NCPDP
discussions,
> >since
> > > >we need to keep straight regarding which Standards Development
> >Organization
> > > >is working on what.
> > > >
> > > >PS2: Is there any practical way to post your modeling outputs for
> >advance
> > > >review by these groups? I can post them to the appropriate
listservs
> if
> >you
> > > >can create them.
> > > >
> > > >PS3: I just cleaned up the below discussions a bit to make it
easier
> for
> > > >others to review the earlier discussions.
> > > >
> > > >PS4: Can anyone out there answer Chris' questions regarding how we
> >approach
> > > >these issues? As you know, I am a "beginner" with this group....
> > > >
> > > >----- Original Message -----
> > > >
> > > >From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]>
> > > >To: "Larry Watkins" <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>
> > > >Cc: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; "Ken Wood"
> > > ><[EMAIL PROTECTED]>; "Maria Ward" <[EMAIL PROTECTED]>
> > > >Sent: Saturday, July 21, 2001 8:23 AM
> > > >Subject: RE: specifications for vision devices
> > > >
> > > >
> > > > Larry,
> > > >
> > > >What exactly do I have to do to get this on the Modeling task
group's
> > > >agenda? It would probably also help me to look over the
work-products
> of
> > > >that group and/or works-in-progress, so that I can better understand
> the
> > > >group's approach to modeling. The one I have evolved into over the
> last
> > > >few years is what I believe is called "entity relationship"
modeling.
> >That
> > > >is, I have tried to identify all of the people, places, and things
that
> >are
> > > >related to *creating* vision care and *delivering* it to the
patient.
> >Then
> > > >I've attempted to list all the attributes of each vision care entity
> and
> >to
> > > >enumerate all of the possible values (data type, etc.) for each
> >attribute.
> > > >Finally, I have tried to define the elements of each relationship
that
> >each
> > > >entity has with all of the others... mandatory vs. optional,
> identifying
> >vs.
> > > >non-identifying, "child" vs. "parent", etc. as they are used in the
> >various
> > > >business processes. There are different ways to express all of this
> > > >graphically and in words, and I'd like to know what the modeling
group
> is
> > > >accustomed to doing so that I can summarize my own work in that way.
> > > >
> > > > I look forward to the Sept-Oct X12 meeting. What would you say
our
> >next
> > > >logical step, as an industry, would be... assuming, of course, that
a
> >broad
> > > >cross section of the vision care industry supports these concepts at
> our
> >own
> > > >Sept. 20 Standards Summit in Las Vegas and wants me to help
represent
> >them
> > > >to X12?
> > > >
> > > >A second question, Larry, is whether someone from the X12 modeling
> group
> > > >would want to actually be present for the Las Vegas meeting. At the
> >moment,
> > > >Bruce Horn has offered to help facilitate a general HIPAA
> > > >presentation/discussion and Peter Barry has offered to come and
speak
> >about
> > > >the DDE issues that impact the most popular electronic claim system
> being
> > > >used in Vision care. Our meeting agenda details are still being
worked
> >out,
> > > >but I will be going directly from that meeting to the X12 meeting in
> > > >Miami... so I'd like to be able to collect and bring along some sort
of
> > > >"industry-input" to the X12 meeting. I'm open to ANY suggestions in
> this
> > > >regard.
> > > >
> > > > Thanks again (to the whole forum) for all your help.
> > > >
> > > > Regards,
> > > >Chris
> > > >
> > > > At 12:03 AM 7/21/01 -0400, Larry Watkins wrote:
> > > >
> > > >To be honest, I'm not sure. As I said before, I'd like to see this
> > > >discussed in the X12N modeling task group. X12N has done some
> extensive
> > > >work on what goes in a claim vs. an attachment, so it would be good
to
> > > >include some of the folks involved in that as well. Maria Ward with
> >First
> > > >Consulting (I'm copying her on this) is one person that comes to
mind.
> >Keep
> > > >in mind that there is a whole group of folks in both X12 and HL7 who
> are
> > > >designing attachments. We want to make sure your work is
coordinated
> >with
> > > >them to do what you describe below. Hope this helps.
> > > >
> > > >Regards,
> > > >Larry
> > > >
> > > >-----Original Message-----
> > > >
> > > >From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]]
> > > >Sent: Friday, July 20, 2001 6:54 PM
> > > >To: Larry Watkins; [EMAIL PROTECTED]
> > > >Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]; Ken Wood
> > > >Subject: RE: specifications for vision devices
> > > >
> > > >Larry,
> > > >
> > > >I will make plans to attend the October X12 meeting, and I agree
with
> >your
> > > >recommendation to start with "modeling". I think that a consensus
is
> > > >building, however, around the idea of creating an attachment for the
> >837-P
> > > >that can completely specify the "patient's optical prescription".
The
> > > >payload of such an attachment would require some extensive, code set
> > > >development work, but much of it already exists in draft form. I
> >envision
> > > >this attachment describing not only the biometric data about the
> patient
> > > >(refractive status, eyeball curvature, etc.), but also the detailed
> > > >information about the eyewear device in its final/dispensed form
that
> one
> > > >would expect to find on a "lab purchase order" from a doctor. It
> should
> > > >also contain the doctor's "orders" or recommendations about how the
> >device
> > > >should be used, the expiration date of the prescription, and
possibly
> >some
> > > >other "Rx" information.
> > > >
> > > >A document like this would also solve a boatload of NON-HIPAA
problems
> >in
> > > >Vision Care... particularly the parts of the attachment that
contained
> > > >"purchase order" information. I believe this will be a very
> satisfactory
> > > >solution for the Payors. The only specific 837-related issue that
I'm
> >aware
> > > >of is a need expressed by one payor to report patient co-pays at the
> >service
> > > >line level, rather for the whole claim. Most vision plans specify
> > > >co-payments for each line-item component of the eyewear claim and
some
> > > >payors want the doctor to report the amounts that were actually
charged
> >to
> > > >the patient for each line item. Other than that, the 837-P might
work
> > > >"right out of the box" for us if we had a robust container for all
the
> > > >eyewear data.
> > > >
> > > >If this is a reasonable approach, Larry, then the bulk of our work
> would
> > > >seem to be in the HL7 and LOINC arena. Would you agree?
> > > >
> > > >-Chris
> > > >
> > > >At 06:24 PM 7/20/01 -0400, Larry Watkins wrote:
> > > >
> > > >I'd like to see us do this in the context of X12, if X12 is the
> direction
> > > >the Vision 'industry' takes with their data needs. They are also
> looking
> >at
> > > >the possibility of doing this work within NCPDP. Jan, my reaction
was
> >much
> > > >the same when Chris and I had a detailed discussion about the needs
of
> >the
> > > >Vision 'industry'. A separate implementation guide would seem to be
> > > >appropriate.
> > > >
> > > >Chris
> > > >
> > > >We would love to have this discussion within the X12 meetings. If
that
> > > >occurs, I'd like to see it start within the Business and Data
Modeling
> >ask
> > > >Group. This group can then assist you and others in determining the
> > > >appropriate mechanism to meet Vision needs, and getting that effort
> >started
> > > >within the appropriate work group -- in this case, the claims work
> group
> >Jan
> > > >mentions below. Where are you in determining which standard you
will
> >use?
> > > >
> > > >Regards,
> > > >
> > > >Larry Watkins
> > > >Vice President & COO
> > > >Claredi Corporation
> > > >Office: (801) 444-0339 x204
> > > >Mobile: (770) 331-1898
> > > >e-Mail: [EMAIL PROTECTED]
> > > >
> > > >-----Original Message-----
> > > >
> > > >From: Jan Root [mailto:[EMAIL PROTECTED]]
> > > >Sent: Wednesday, July 18, 2001 5:20 PM
> > > >To: [EMAIL PROTECTED]
> > > >Cc: [EMAIL PROTECTED]
> > > >Subject: Re: specifications for vision devices
> > > >
> > > >Chris
> > > >
> > > >Wow - this is terrific information. I wish you had been at X12
about
3
> >or 4
> > > >years ago! I'd be happy to work with you individually to see how
some
> of
> > > >this information might fit into the 837 (I was the primary author on
> the
> >837
> > > >professional imp guide for HIPAA), but it almost sounds as if you
might
> >want
> > > >to consider developing a 'vision' 837 (we have three and 1/2 flavors
of
> >837
> > > >already, what's one more??). On the surface, it seems to be a very
> > > >different business model than the professional claim. The WG could
not
> > > >build in a way to handle the information you list because there was
no
> >one
> > > >in the workgroup who filed vision claims - no one knew what you just
> > > >explained.
> > > >
> > > >Anyway, let me know and we could set up some time to talk if you
think
> >that
> > > >would be productive. Another alternative would be for you (or some
> other
> > > >knowledgeable vision person (from the provider side)) to attend
several
> >X12
> > > >meetings and bring it up as an agenda item for the 837 WG. In that
> case
> >you
> > > >probably want to contact one of the 837 Co-Chairs (listed on the X12
> web
> > > >site).
> > > >
> > > >j
> > > >
> > > >"Christopher J. Feahr, OD" wrote:
> > > >
> > > >One of the areas yet to be determined for claims involving
eyeglasses
> and
> > > >contact lenses is exactly how we will specify the particular device.
> > > >Virtually all spectacle lenses and perhaps 20% of the contact lenses
> are
> > > >custom, one-of-a-kind devices that are made from a detailed purchase
> >order
> > > >created by the doctor. Since there are other business needs for
> >electronic
> > > >purchase orders (than to support insurance claims) I have been
focusing
> >on
> > > >it. But overlapping sets of this information exists in other
medical
> > > >records, for which there is also a pressing need to develop digital
> > > >standards. For example, "Patient's Prescription for Glasses (or
> contact
> > > >lenses)" is generally considered to be a collection of biometric
data
> >about
> > > >the patient's eyes (refractive measurements, corneal curvature,
> distance
> > > >between eyeballs, etc), but the "prescription" is really a
"physician
> >order"
> > > >about what device to make and how it should be worn or used. So it
> >includes
> > > >varying amounts of specific product information (a particular brand
of
> >lens,
> > > >for example) along with the biometrics.
> > > >
> > > >To complicate matters further, there are some measurements (e.g.,
the
> > > >distance between the eyeballs) that *should* be part of the
> >"prescription",
> > > >but are typically left up to the dispensing optician to measure and
> write
> > > >onto the "purchase order"... and the optician may have sound reasons
> >(based
> > > >on optical issues like prismatic effects) to enter a DIFFERENT
number
> on
> >the
> > > >purchase order for "distance between eyes" from the patient's true
> >biometric
> > > >value, identified in his medical record as "pupillary distance".
> > > >
> > > >So, to summarize, we have groupings of patient biometric data,
product
> > > >specifications that the doctor wants to "prescribe", product
> >specifications
> > > >that any optician or the patient himself can choose at the time of
> order,
> > > >the complete set of specifications a lab would need to make the
device,
> > > >specification of the lens product attributes from the point of view
of
> >the
> > > >lens manufacturer (as opposed to a specific patient order), and the
> >general
> > > >class-level specification that is provided by the level II HCPCS
codes.
> > > >
> > > >A particular insurance payor may potentially want to see ANY of this
> >data...
> > > >Oh, then there is the "invoice" which would contain some of the
product
> > > >specifications and wholesale prices for each component... and the
payor
> > > >often wants to ALSO see doctor's normal RETAIL prices!
> > > >
> > > >I have developed standard schemas for all of this stuff over the
last
5
> > > >years, but I do not have a clue how to fit it into the transactions
> sets
> > > >that X12 has been working on.
> > > >
> > > >Any thoughts?
> > > >
> > > >Regards,
> > > >
> > > >Chris
> > > >
> > > >Christopher J. Feahr, OD Vision Data Standards Council
> > > >Executive Director http://visiondatastandard.org
> > > >Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
> > > >
> > > >
> > > >
> > >
>**********************************************************************
> > > >To be removed from this list, send a message to:
> [EMAIL PROTECTED]
> > > >Please note that it may take up to 72 hours to process your request.
> > >
> > > Christopher J. Feahr, OD Vision Data Standards Council
> > > Executive Director http://visiondatastandard.org
> > > Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
> > >
> > >
> > >
**********************************************************************
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> [EMAIL PROTECTED]
> > > Please note that it may take up to 72 hours to process your request.
>
> Christopher J. Feahr, OD Vision Data Standards Council
> Executive Director http://visiondatastandard.org
> Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
>
>
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