See excerpt from Trans. and Code Set Final Rule, Federal Register, pg 25,280.
D. Data Content
We propose standard data content for each adopted standard. There
are two aspects of data content standardization: (1) Standardization of
data elements, including their formats and definition, and (2)
standardization of the code sets or values that can appear in selected
data elements. A telephone number is an example of a data element that
has a standard definition and format, but does not have an enumerated
set of valid codes or values. A patient's diagnosis is an example of a
data element that has a standard definition, a standard format, and a
set of valid codes. Information that would facilitate data content
standardization, while also facilitating identical implementations,
would consist of implementation guides, data conditions, and data
dictionaries, as noted in the addenda to this proposed rule, and the
standard code sets for medical data that are part of this rule. Data
conditions are rules that define the situations when a particular data
element or record/segment can be used. For example, ``the name of the
tribe'' applies only to Indian Health Service claims. The defining rule
for that data element would be ``must be entered if claim is Indian
Health Service''.
1. Data Element and Record/Segment Content
Once we publish the final rule in the Federal Register and it is
effective, there will be no additional data element or record/segment
content modifications in any of the transactions for at least one year.
In our evaluation and recommendation for each proposed standard
transaction, we have tried to meet as many business needs as possible
while retaining our commitment to the guiding principles. We encourage
comments on how the standards may be improved.
It is important to note that all data elements would be governed by
the principle of a maximum defined data set. No one would be able to
exceed the data sets defined in the final rule, until that rule is
amended one or more years from the effective date of the final rule.
This means that if a transaction has all of the data possible--based on
the appropriate implementation guide, data content and data conditions
specifications, and data dictionary--then a health plan would have to
accept the transaction and process it. This does not mean, however,
that the health plan would have to store or use information that it
does not need in order to process a claim or encounter, except for
audit trail purposes or for coordination of benefits if applicable. It
does mean that the health plan would not be able to require additional
information, and it does mean that the health plan would not be able to
reject a transaction because it contains information the health plan
does not want. This principle applies to the data elements of all
transactions proposed for adoption in this proposed rule.
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