The information in this presentation is confidential and considered proprietary to Palmetto GBA. The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030

DEBORAH BROWN, PALMETTO GBA

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

9/1/2016 PALMETTO GBA 2

No? Maybe?

Yes?

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

9/1/2016 PALMETTO GBA 3

Cost

Mandate

Need

Lessons Learned

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

X12N TRANSACTIONS RECOMMENDED FOR ADOPTION

ASC X12N 277 Health Care Claim Request for Additional Information

ASC X12N 278 Health Care Services Review Request for Review and Response

ASC X12C 999 Implementation Acknowledgement for Health Care Insurance

ASC X12C TA1 Acknowledgement Segment ASC X12N 275 Additional Information to Support a

Health Care Claim or Encounter ASC X12N 275 Additional Information to Support a

Health Care Services Review

9/1/2016 PALMETTO GBA 4

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

X12N PUBLIC COMMENT PERIOD TIMELINE FOR VERSION 7030 TR3s

Cycle 1: September 1 - October 31, 2016 007030X334 Payroll Deducted and Other Group

Premium Payment for Insurance Products (820) 007030X345 Health Insurance Exchange Related

Payments (820) 007030X333 Benefit Enrollment and Maintenance

(834) 007030X346 Health Insurance Exchange: Enrollment

(834) 9/1/2016 PALMETTO GBA 5

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

Cycle 2: October 1 - November 30, 2016 007030X329 Health Care Claim Status Request

and Response (276/277) 007030X330 Health Care Claim Acknowledgment

(277CA) 007030X331 Health Care Claim Pending Status

Information (277P) 007030X335 Implementation Acknowledgment

for Health Care Insurance (999)

9/1/2016 PALMETTO GBA 6

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

Cycle 3: November 1 - December 31, 2016 007030X322 Health Care Claim Payment/Advice

(835)

3/5/2014 PALMETTO GBA 7

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

Cycle 4: December 1, 2016 - March 1, 2017 007030X323 Health Care Claim:

Professional (837P) 007030X324 Health Care Claim:

Institutional (837I) 007030X325 Health Care Claim: Dental

(837D) 007030X326 Health Care Service: Data

Reporting (837R) 9/1/2016 PALMETTO GBA 8

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

Cycle 5: February 1 - April 2, 2017 007030X332 Health Care Eligibility/Benefit

Inquiry and Information Response (270/271)

3/5/2014 PALMETTO GBA 9

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

Cycle 6: March 1 - April 30, 2017 007030X327 Health Care Services Review

Inquiry and Response (278) 007030X328 Health Care Services Review -

Notification and Acknowledgment (278) 007030X342 Health Care Services Request

for Review and Response (278)

9/1/2016 PALMETTO GBA 10

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

Cycle 7: April 1 - May 31, 2017 007030X321 Application Reporting for

Insurance (824) 007030X340 Health Care Claim Request for

Additional Information (277RFI) 007030X341 Additional Information to

Support a Health Care Claim or Encounter (275)

007030X343 Additional Information to Support a Health Care Services Review (275)

9/1/2016 PALMETTO GBA 11

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

Cycle 8: May 1 - June 30, 2017 007030X339 Health Care Fee Schedule (832)

3/5/2014 PALMETTO GBA 12

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

9/1/2016 PALMETTO GBA 13

NO It’s too soon to get involved.

Cannot justify expense.

There is no legislative mandate.

My business needs are met

with X12 version 5010.

Higher priorities require my resource

investment.

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

Maybe

Prefer to wait it out.

Small resource

availability.

There may be changes

that are beneficial to our business.

9/1/2016 PALMETTO GBA 14

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

YES

Certain that X12 version 7030

includes changes we want to implement.

Already expended resources as

participants in the X12 development

process.

Resources have been budgeted and approved.

9/1/2016 PALMETTO GBA 15

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

9/1/16 PALMETTO GBA 16

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

REFERENCES

1. X12N Transactions Recommended for Adoption http://www.ncvhs.hhs.gov/wp-content/uploads/2013/12/2016-Ltr-Attachments-July-1-Final-Chair-CLEAN-for-Submission-Publication.pdf 2. X12N Public Comment Period Timeline for Version 7030 TR3s http://www.x12.org/x12org/prdoc.cfm?Name=1275 3/5/2014 PALMETTO GBA 17

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

X12 TRANSACTIONS VERSION 7030 Do I Care?

ACRONYMS

DHHS- Department of Health and Human Services HIPAA- Health Insurance Portability and Accountability Act of 1996 HL7- Health level Seven International LOINC- Logical Observation Identifiers Names and Codes MACRA- Medicare Access & CHIP Reauthorization Act of 2015 NCPDP- National Council for Prescription Drug Programs NCVHS- National Committee on Vital and Health Statistics NPRM- Notice of Proposed Rule Making

3/5/2014 PALMETTO GBA 18

The information in this presentation is confidential and considered proprietary to Palmetto GBA.

9/1/2016 PALMETTO GBA 19