2011 10 18 esMD Kickoff Presentation
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ASC X12/HL7 ESMD AND DATA PAYLOAD STANDARDS Gary Beatty Deloitte Consulting GOAL OF ESMD 2 ESMD EVOLUTION CMS: Paper Requests Providers choose response type: • Paper • CD (PDF/TIFF) • Fax 3 ESMD EVOLUTION CMS: Paper Requests Providers: • Unstructured content XDR 4 ESMD EVOLUTION CMS: Paper Requests Providers: • Unstructured content X12 275/HL7 CDA 5 ESMD EVOLUTION CMS: X12 277 Health Care Claim Request for Additional Information Providers: • Unstructured content X12/HL7 6 ESMD EVOLUTION CMS: X12 277 Health Care Claim Request for Additional Information Providers: • Structured content X12 275/HL7 CDA 7 X12 TRANSACTIONS 837 Health Care Claim HIH 277 Health Care Claim Request for Additional Information Medicare Gateway 275 Additional Information to Support a Health Care Claim or Encounter ASC X12 275 - 005010X210 ASC X12 277 – 005010X213 8 277 AND 275 WORKING TOGETHER A 277 asks for A 275 Returns • Entire Attachment or • Section/Entry of Attachments • Section/Entry of Attachments Consisting of • Answer part(s) Electronic Attachment Section/Entry Section/Entry Section/Entry Section/Entry Section/Entry Section/Entry Section/Entry - By sending LOINC Section/Entry Answer Part Section/Entry Answer Part Section/Entry Answer Part - Identified using LOINC 9 277 HEALTH CARE CLAIM REQUEST FOR ADDITIONAL INFORMATION Loop ID Loop Name 2000A Payer Name Loop 2000B Information Receiver Loop 2000C Service Provider Information Loop 2000D Patient Loop 2100D Patient Name Loop 2200D Payer Claim Control Number Claim Level Status Information Claim Supplemental Information >1 >1 1 Service Line Information Service Level Status Information >1 >1 2210D 2220D Loop Repeat 1 1 >1 >1 1 10 275 ADDITIONAL INFO TO SUPPORT A HEALTH CARE CLAIM OR ENCOUNTER Loop ID Loop Name Loop Repeat 1000A Payer Name 1 1000B Submitter Information 1 1000C Provider Name Information 1 1000D Patient Name 1 2000A Assigned Number 2100A Service Line Date of Service 1 2100B Additional Information – Submission Date 1 2110B Electronic Information Identification 1 >1 11 INTERCHANGE CONTROL STRUCTURE ASC X12 Interchange Control Header ASC X12 Transaction Set Control Trailer ASC X12 Functional Group Trailer ASC X12 Interchange Control Trailer Message Envelope (CORE Connectivity Rule SOAP) Binds to Transport Protocol (HTTP) Transaction 275 with PDF in HITSP C62 (1 Beneficiary / 1 Claim) Interchange Envelope ASC X12 Transaction Set Control Trailer Functional Group Envelope ASC X12 Functional Group Header Message Envelope (CORE Connectivity Rule SOAP) Message Envelope (CORE Connectivity Rule SOAP) 12 X12 ACKNOWLEDGMENTS 837 Health Care Claim 277 Health Care Claim Request for Additional Information HIH 275 Additional Information to Support a Health Care Claim or Encounter Medicare Gateway TA1 / 999 Negative Acknowledgment 834 Positive / Negative Acknowledgment 13 HL7 CLINICAL DOCUMENT ARCHITECTURE (CDA) Unstructured Clinical Information Human Decision Variant Structured Clinical Information Computer Decision Variant 14 HL7 CDA BASIC STRUCTURE Unstructured clinical information - packaged into a Multipart Mime package <ClinicalDocument> <body> </body> </ClinicalDocument> 15 ESMD METADATA WITHIN HL7 CDA Metadata HL7 CDA Author <Author> Person <assignedAuthor> Author Institution <representedOrganization> Class Code <code> Class Code Display Name <title> Confidentiality Code <confidentialityCode> Creation Time <effectiveTime> entryUUID <id> Healthcare Facility Type Code <representedOrganization><typeId> Healthcare Facility Type Code Display Name <representedOrganization><name> Language Code <languageCode> Patient ID <recordTarget><patientRole><patient><id> 16 ESMD METADATA WITHIN HL7 CDA Metadata HL7 CDA Practice Setting Code <healthCareFacility> code <= ServiceDeliveryLocationRoleType Practice Setting Code Display Name <healthCareFacility> code <= ServiceDeliveryLocationRoleType Service Start Time Service Stop Time <DocumentationOf><ServiceEvent> <effectiveTime> 17 SAMPLE ESMD TRANSACTION 18 CDA TEMPLATES XML Based Single Imp. Guide Template is set of constraints on full CDA standard Computer Decision Variant (Structured Data) Human Decision Variant (Unstructured Data) 19 CDA TEMPLATES Reusable Abbreviated Development Cycle Templates can be transformed to source code Data Entry Form 20 Thesaurus Discharge Summary 1 Translation Standardization Discharge Summary 2 EHR Discharge Summary Discharge Summary 1 Style Sheet Discharge Summary 2 Style Sheet Thank you! Gary Beatty gbeatty@deloitte.com 22
