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]
----- Original Message -----
From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>
Cc: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>;
<[EMAIL PROTECTED]>
Sent: Friday, January 11, 2002 7:59 PM
Subject: Is it "claim" or is it "attachment"?
Back in the early 90s (I'm told) a consensus began to form regarding
which
specific data elements would constitute "The Claim" and which would be
considered "Additional Information". My understanding is that the key
determining factor was whether the data was needed by most payors most
of the time or whether it was only occasionally needed in special or
unusual
situations. Presumably (I wasn't involved in the discussions) this
"Claim"
vs. "Additional Information" issue was worked out separately for
retail
pharmacy, institutional care settings, outpatient/general medical
settings,
and dentists... culminating eventually in the 4 HIPAA "claim"
standards,
with the rest of the data targeted for Claim Attachment standards at a
later date.
My question for those who did participate in this discussion is: Based
on
what you now know of the unique data requirements for commercial
vision/eyewear claims, should the patient's refractive status
information
and the description of the eyewear be considered to be part of the
"claim"? For optometric and lab providers, the vast majority of
eyewear
claims (at least 70% of them) require highly specific proprietary
coding to
describe the eyewear and a significant number (maybe 30 to 50%)
require at
least some information about the patient's present and/or prior
refractive
status or visual acuity. As an optometric provider, I would
unequivocally
label this "claim information"... i.e., most of my payors require it
most
of the time.
Not only do most payors require it most of the time, but transmitting
this
data represents most of my insurance headache. Every single payor in
this
space has a different claim format and over 90% of these claims (in my
typical, California office) must be hand-keyed into the payor's
proprietary
DDE forms using a standard web-browser.
As some of you know, we have been discussing the feasibility of
developing
an attachment standard for this information, but the more I think
about
this, the more clear it becomes to me that this is "claim" data. Of
course, it does not fit into any of the 4 existing claim standards,
meaning
that we would have a "big problem" with such a designation. On the
other
hand, calling this information "attachment" data effectively moves the
deadline for implementing standards far into the future and provides
no
incentive for commercial vision payors to even come to the X12
meetings to
explain their needs. Lack of interest in claim standards within the
payor
community is the main reason that the vision industry has been
unsuccessful
in developing data standards for 20 years. We need HIPAA to be the
galvanizing force that it was meant to be... to be the stimulus that
propels the vision industry toward data standardization.
Mechanically, it is very appealing to approach this extra detail about
the
glasses and the patient's refractive status as "attachment" data. It
is
not entirely clear that the combination of an 837-P and a "vision
attachment" will satisfy all vision payor needs, but the consensus at
this
week's ASIG meeting among a group of payors representing approx. 80%
of the
vision industry, was that it would probably work OK. I am absolutely
convinced that it would be POSSIBLE to create the needed code set and
messaging structure for such an attachment and to implement it by Oct.
2003
(or darned close to it). Without that deadline, however, our success
would
be far less certain.
For 35,000 optometrists, this represents our MAIN insurance
headache...
arguably our main business headache. We need the standards and we
need the
deadlines imposed by HIPAA to ensure that standards are created in a
timely fashion. Any suggestions regarding how to accomplish this
within the
context of the present law would be most appreciated.
I want to thank this community for all the guidance and counsel that
you
have provided me over that last year or so. Tuesday's meeting in San
Diego
(ASIG/HL7) was truly an historic one for our industry and I feel that
with
the proper incentives in place we are now in an excellent position to
do
what we have been trying to do (on our own) for two decades without
success.
Best regards,
Chris
Christopher J. Feahr, OD
http://visiondatastandard.org
[EMAIL PROTECTED]
Cell/Pager: 707-529-2268
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