Zon
If this is discussed at X12 I think it's imparative that claims the
attachment workgroup in HL7 is involved. This could include Gale Carter,
me, Mike Cabral, Joanne Weingarth, Chris Stahlecker, Durwin Day and more...
Please advise when and where HL7 needs to be represented.
Thanks
Maria
-----Original Message-----
From: Zon Owen [mailto:[EMAIL PROTECTED]]
Sent: Saturday, July 21, 2001 3:46 PM
To: Christopher J. Feahr, OD; [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: Specifications for Vision Devices
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]
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