Get ready for HL7 CDA-based attachments to ASC X12 claims

With all the recent talk about eHealth 2.0, EMRs, PHRs, and consumer driven healthcare we may sometimes forget that some of us are involved in the dirty, rotten, tiresome, and difficult job of getting their firms paid for services. HIPAA did a decent job of standardizing electronic claims with the ASC X12 837 transaction sets and payers and clearinghouses were good about supporting it but one big thing was missing: attachments for documents required to prove the rendered services.

Well, after many years of hard work HHS’s proposed rules (NPRM) on healthcare claims attachments were published in late September (see the associated press release).

As most of us already know, the claims attachments proposal is designed to allow HL7-based Clinical Document Architecture (CDA) attachments to be sent along with ASC X12 transaction sets from providers to payers. There is a great deal of benefit for providers (hospitals, docs, etc) and payers will be coming along kicking and screaming for the most part.

What should you be doing about it?

• Understand what the attachment types are and get used to hearing about electronic claims attachments. They’re optional for providers but mandatory for payers if providers supply the attachments. See this nice preparing for the regulations white paper.
• Attend the HL7 introductory conference calls on the subject. The first one is on November 30 and another one is on December 6.
• Check with the payers you work with the most to see how soon they’ll start supporting claims attachments.

By the way, the WEDI/HL7/X12/AFEHCT National Healthcare Claims Attachment Survey Final Report has been available for a couple months; the survey reports that most providers commonly send the following types of attachments to payers:

• Laboratory Results
• Medications
• Clinical Reports
• Alcohol Substance Abuse Rehabilitation
• Cardiac Rehabilitation
• Medical Social Services
• Occupational Therapy Rehabilitation
• Physical Therapy Rehabilitation
• Speech Therapy Rehabilitation
• Respiratory Therapy Rehabilitation
• Psychiatric Rehabilitation
• Skilled Nursing Rehabilitation
• Emergency Department
• Ambulance Service
• DME
• Home Health Services
• Periodontal Services
• Children’s Preventive Health Services
• Consent
• Administrative/non clinical information