Gary Beatty Deloitte Consulting

2

CMS: Paper Requests Providers choose response type: Paper CD (PDF/TIFF) Fax 3

CMS: Paper Requests Providers: Unstructured content XDR 4

CMS: Paper Requests Providers: Unstructured content X12 275/HL7 CDA 5

CMS: X Health Care Claim Request for Additional Information Providers: Unstructured content X12/HL7 6

CMS: X Health Care Claim Request for Additional Information Providers: Structured content X12 275/HL7 CDA 7

HIH Medicare Gateway 837 Health Care Claim 277 Health Care Claim Request for Additional Information 275 Additional Information to Support a Health Care Claim or Encounter 8 ASC X X210 ASC X – X213

9 A 277 asks for Entire Attachment or Section/Entry of Attachments A 275 Returns Section/Entry of Attachments Consisting of Answer part(s) Electronic Attachment Section/Entry Answer Part Section/EntryAnswer Part Section/EntryAnswer Part - By sending LOINC - Identified using LOINC

10 Loop IDLoop Name Loop Repeat 2000APayer Name Loop BInformation Receiver Loop CService Provider Information Loop >1 2000DPatient Loop >1 2100DPatient Name Loop DPayer Claim Control Number >1 Claim Level Status Information >1 2210DClaim Supplemental Information DService Line Information >1 Service Level Status Information >1

11 Loop IDLoop Name Loop Repeat 1000APayer Name BSubmitter Information CProvider Name Information DPatient Name AAssigned Number >1 2100AService Line Date of Service BAdditional Information – Submission Date BElectronic Information Identification 1

12

13 HIH Medicare Gateway 837 Health Care Claim 277 Health Care Claim Request for Additional Information 275 Additional Information to Support a Health Care Claim or Encounter TA1 / 999 Negative Acknowledgment 834 Positive / Negative Acknowledgment

Structured Clinical Information Computer Decision Variant 14 Unstructured Clinical Information Human Decision Variant

15 Unstructured clinical information - packaged into a Multipart Mime package

16 MetadataHL7 CDA Author Person Author Institution Class Code Class Code Display Name Confidentiality Code Creation Time entryUUID Healthcare Facility Type Code Healthcare Facility Type Code Display Name Language Code Patient ID

17 MetadataHL7 CDA Practice Setting Code code <= ServiceDeliveryLocationRoleType Practice Setting Code Display Name code <= ServiceDeliveryLocationRoleType Service Start Time Service Stop Time

18

19  XML Based  Single Imp. Guide  Template is set of constraints on full CDA standard  Computer Decision Variant (Structured Data)  Human Decision Variant (Unstructured Data)

20  Reusable  Abbreviated Development Cycle  Templates can be transformed to source code  Data Entry Form

Discharge Summary 1 Discharge Summary 2 Discharge Summary EHR Translation Standardization Thesaurus Style Sheet Discharge Summary 1 Discharge Summary 2

22 Gary Beatty Thank you!