Health Care Attachments to Support Claims, Referrals and Authorizations

Comment

NCPDP - Comment

  • This should be under the main category of V-D: Administrative Transaction to Support Clinical Care.
  • Add a bullet for Standards for referral certification and authorization transaction - Pharmacy

Type-Implementation Specification

Standard Implementation/Specification- NCPDP Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2010

Standards Process Maturity – Final

Implementation Maturity- Production

Adoption Level – 3

Federally Required – Yes

Cost – $

Test Tool Availability –

  • Add a bullet for Standards for referral certification and authorization transaction - Pharmacy

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard Implementation Guide, Version 2013101

Standards Process Maturity – Final

Implementation Maturity- Production

Adoption Level – 2

Federally Required – Yes

Cost – $

Test Tool Availability -

The very large list of…

The very large list of standards in this section suggests that it should be broken up into different interoperability needs. There also seems to be a mix of base standards (X12 Version 6020), implementation guides specific to attachments, and some other general implementation guides that probably don’t need to be listed here because they are pointed to in the attachment specific guides (C-CDA, LOINC Document Ontology IG, Digital signatures, etc). Previously, the HITSC recommended separating out base standards from implementation guides.

Acknowledgments

The American Medical Association appreciates the opportunity to comment. This section includes acknowledgments, however, acknowledgments typically does not support claims, referrals, or authorizations. We believe acknowledgments is misplaced in this section. We understand the reasoning could be because they are lumped together on the regulatory agenda, however the 999 does not seem related. Acknowledgments intersects with multiple transactions, therefore we believe it should have its own section. The guidance claims that two payers have successfully implemented attachments after piloting in 2004. This is inaccurate as the standard that is currently under consideration was not created until 2016. 

NCPDP Comment

  1. Emerging Transaction(s) within NCPDP SCRIPT Standard:
    1. Patient Care Service Referral (ServiceReferral)
    2. Patient Care Service Documentation (ServiceDocumentation)
    3. Response to Request for Patient Care Service Referral (ResponseToReferralRequest)
    4. Request for Patient Care Service Referral (RequestForReferral)
    5. Response to Patient Care Service Referral (ServiceReferralResponse)