Dave,
A proposed list of data elements for spectacle lenses is currently being
reviewed by key members of the vision industry... this is the 60-70 item
list I referred to at the meeting. It addresses most if not all of the
problems with eyeglasses and claims, and it is anticipated that the final
list will have LOINC codes assigned. Similar lists of data elements are
being prepared for "Frames" and for "Contact Lenses", although the ways in
which these two product-types are currently referenced in insurance
transactions does not demand much (if any) greater specificity than is able
to be conveyed with the HCPCS codes. (As you know, there are significant
non-HIPAA, industry needs for these product description codes... mainly
purchasing and EMR).
Eligibility and pre-certification or "pricing query" issues are a whole
separate kettle of fish for us, but I do believe that Kepa's brilliant
suggestion regarding the 837-addenda may obviate the need for a claim
attachment (I realize that you told me to look at the Addenda several mos.
ago, Kepa... but I just didn't get it AND and I didn't understand how the
LOINC codes worked back then).
So I hope to be able to drill into both the addenda proposal and the
"eligibility" issues at X12 and to chart out a firm course for the
industry. Unfortunately, both AOA and VSP have indicated that they cannot
be in Seattle for the X12 meeting. I will be in Seattle Sun through Thurs.
and at least 2 of the payors who were at the ASIG meeting should also be in
attendance... but possibly not for all days.
I realize this listserv is not an official venue for X12 agenda planning,
but there may be a need to add this proposed use of the addenda to the 837
WG agenda in Seattle.
Thanks again... we are making excellent progress!
-Chris
At 11:17 PM 1/16/02 -0800, you wrote:
>Chris,
>
>As I and others expressed at last week's HL7 Attachments Special
>Interest Group (ASIG) meeting, we appear to have reached a point in
>this discussion where more specificity will be required. This
>specificity will have to come from those in the vision industry that
>best understand the stated "50-60" data elements and their code values
>that comprise the core data set needed to process those vision claims
>that need information beyond what can currently be carried in an
>existing 837 HIPAA transaction.
>
>Hopefully writing for many if not all of us who have been working on
>claims and other attachments for many years now, and vision for the
>past year or so, we are hopefully optimistic that the broad set of
>vision industry participants in last week's meeting ("covering over
>80% of the lives in this country"), potentially under the proposed
>auspices of the American Optical Association, will be able to generate
>such a list in reasonably short order.
>
>Once the list of data elements is available for all to see, and an
>understanding / consensus is reached of how many times various items
>from the list are needed relative to not needed, then, and only then,
>can we take the next steps to determine which data elements should be
>included in a claim versus an attachment. Otherwise we're all just
>still speculating [sorry for the pun, it just sort-of slipped in].
>
>Also as many of us noted last week, the joint HL7 / X12N attachments
>team stands ready to facilitate the representatives of the vision
>industry in their data element list definition efforts. We can't do
>it for you, but we are willing to lend our expertise and experiences
>from assisting this process for other industry areas.
>
>Bottom line, let your usual contacts know how we may assist the vision
>industry in bringing it's combined, itemized business needs to the
>fore in the manner we all agreed-to, and we'll make it go.
>
> Dave Feinberg
> Rensis Corporation
> 206-617-1717
> [EMAIL PROTECTED]
>
Christopher J. Feahr, OD
http://visiondatastandard.org
[EMAIL PROTECTED]
Cell/Pager: 707-529-2268
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