The version 004050, plus one version 004040, X12N Implementation
Guides listed below are now available for public comment. The public
review period for these Implementation Guides commenced at 8:00 P.M.
Eastern time on March 28, 2003, and will close at 8:00 P.M. Eastern
time on April 28, 2003.
All but one of the 004050 Implementation Guides represent evolutions
from their version 004010 and 004010A1 counterparts which are
currently adopted under HIPAA. The version 004050 Implementation
Guides may or may not be considered for adoption under HIPAA; no
official discussions on this option have yet commenced. A factor in
any such discussions will be the comments received during the next
thirty days.
The work group authors will review and discuss any and all comments
following the public review period. Official work group responses
will be sent to the individual commenter who submitted the comment and
will be posted to the on-line conference. All work group responses
will be posted at least 15 days prior to a corresponding Information
Forum for each Implementation Guide which will follow the comment
period. This is the only public review period. For a complete
understanding of changes being made to the Implementation Guides,
reviewers should monitor the on-line conference during the public
review period and review all author responses prior to the Information
Forum.
Watch for the announcement of corresponding Information Forums. These
Information Forums are the final opportunity to comment on
modifications based on the public review period comments.
The draft Implementation Guides are:
834, Benefit Enrollment and Maintenance (004050X125)
� Transfer enrollment information from the sponsor of insurance
coverage, benefits, or policy to a payer.
820, Payroll Deducted and Other Group Premium Payment for Insurance
Products (004050X137)
� Transmit payroll deducted premiums for a wide variety of
insurance products, to include life, health, property and
casualty, and disability.
276/277, Health Care Claim Status Request and Response (004050X139)
� Request the status of health care claim(s) and respond with
information regarding the specified claim(s).
278/278, Health Care Services Request for Review and Response
(004050X140)
� Health care admission certificate requests and responses
� Referral requests and responses
� Health care services certification requests and responses
� Extend certification requests and responses
� Certification appeal requests and responses
837, Health Care Claim: Institutional (004050X141)
� Submit and transfer institutional claims and encounters from
health care providers to health care payers
837, Health Care Claim: Dental (004050X142)
� Submit and transfer dental claims and encounters from health
care providers to health care payers
837, Health Care Claim: Professional (004050X143)
� Submit and transfer professional claims and encounters from
health care providers to health care payers and between payers
277, Health Care Claim Acknowledgment (004040X167)
� Provide claim status information from the payer without health
care provider solicitation. For example, acknowledgment of
a health care claim transmission.
274 Health Care Provider Directory Implementation Guide (004050X109)
� Transmit provider directory information to providers
� Transmit provider directory information to other payers or
State and Federal programs
� Transmit provider directory information to employers
The draft Implementation Guides are available for download at:
http://www.wpc-edi.com/HealthCareDraft.asp
Comments on the draft Implementation Guides can be submitted via the
on-line conference at:
http://www.wpc-edi.com/conferences/healthcare.html
Note that the Implementation Guide
835, Health Care Claim Payment/Advice (004050X124)
� Make payment on a health care claim
� Send an Explanation of Benefits (EOB) remittance advice
� Make payment and send an EOB in the same transaction
is not included in the above list. This Implementation Guide has
already been approved by X12N for publication.
Participation in the announced review is open to all who may be
interested. Please participate if you are able.
Dave Feinberg
Co-Chair, HIPAA Implementation Work Group
Insurance Subcommittee (X12N)
Accredited Standards Committee X12
Rensis Corporation [A Consulting Company]
206-617-1717
[EMAIL PROTECTED]
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