ANSI ASC X12 Change Process 101 (.pdf)

ANSI ASC X12 Glossary

Encounter Data System Gap Analysis Guidelines

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Encounter Data System Gap Analysis Guidelines. Word of Encouragement This is the most critical step in the process. When first presented with the task of comparing your data needs with those in the 837 claim / encounter standard it seems like a very daunting task. This task is tedious, but it does not have to be daunting. The purpose of this document is to help organize the resources necessary to accomplish the critical step of gap analysis on the 837 claim / encounter standard. You need to know whether or not what you need is supported by the standard or not. Without that knowledge system development efforts cannot successfully move forward. Let's Begin The UB-92 and its predecessor the UB-82 have long been the de facto standard for defining the core data content for billing and reporting of institutional health services. Based on that premise, a logical first step is to analyze the UB content for reporting health services in an institutional setting. Step1A: Compare Your Institutional data requirements to the UB-92 paper and flat file electronic formats. Review the UB-92 Specification document. All of the UB-92 data elements are supported on the 837 claim / encounter standard. The UB-92 Specifications are available on the National Uniform Billing Committee (NUBC) web site - www.nubc.org. Note: you must be a subscriber to obtain the data specifications. Instructions for becoming a subscriber are available on the web site. There is a nominal cost to become a subscriber. Review the current Medicare flat file UB formats. Version 5 was developed as part of Y2K compliance. Version 6 was subsequently developed to accommodate recent Medicare billing requirements. Each of these formats can be downloaded from the following web site: http://www.hcfa.gov/medicare/edi/edi3.htm. Review Version 5 or Version 6 mappings to the 837 Institutional claim / encounter standard. These mappings are available in an ACCESS database on the Medicaid HIPAA Conceptual Concept Model (MHCCM) web site at the following URL: http://www.hhsc.state.tx.us/MHCCM/default.htm. Review a variety of crosswalks to and from the 837 Institutional claim / encounter standard. These crosswalks are available on the Medicaid HIPAA Conceptual Concept Model (MHCCM) web site at the following URL: http://www.hhsc.state.tx.us/MHCCM/default.htm Review the hard copy UB-92 (also called the CMS-1450 / HCFA-1450) form. This is available at the following URL in PDF format. http://www.hcfa.gov/medicare/edi/edi5.htm. The HCFA 1500 has been the de facto standard for defining the core data content for billing and reporting of professional health services. Based on that premise, a logical first step is to analyze the HCFA 1500 content for reporting health services in a professional setting. Step1B: Compare Your Professional data requirements to the CMS (HFCA) 1500 paper form or the National Standard Format (NSF) flat file format. Review the current Medicare flat file NSF format. This format can be downloaded from the following web site: http://www.hcfa.gov/medicare/edi/edi3.htm. Review a variety of crosswalks to and from the 837 Professional claim / encounter standard. These crosswalks are available on the Medicaid HIPAA Conceptual Concept Model (MHCCM) web site at the following URL: http://www.hhsc.state.tx.us/MHCCM/default.htm Review the hard copy CMS-1500 (also called the HCFA 1500) form. This is available at the following URL in PDF format. http://www.hcfa.gov/medicare/edi/edi5.htm Step 2: Identify your data needs that are NOT supported in the ANSI ASC X12 standard. (See note about implementation guides in the ANSI ASC X12 Glossary) Review the 837 standard, which may be purchased in hard copy from Washington Publishing Company (www.wpc-edi.com) or downloaded from the following URL (http://www.x12.org/apps/wbsignup/), which is available to organizations or individuals that are ANSI ASC X12 members. The purpose of this review is to identify those necessary elements that are either: Supported in the 837 standard, but not in the UB or HCFA data specifications. Potentially supportable through changes to external codes lists; such as the UB value, revenue, condition, or occurrence codes. Potentially supportable through changes to the ANSI ASC X12 standard. · See Gap Analysis spreadsheet for data element information from various state discharge systems. (Note: This spreadsheet is under development)