HL7 Periodontal Claims Attachment Workgroup Minutes

HL7 Periodontal Claims Attachment Workgroup Minutes

Friday, April 23, 2004

MEETING DATE:April 23, 2004

MEETING LOCATION:Via Conference Call at 3 p.m., C.D.T.

Participants: Theresa Jansen (UCCI); Barb Brinser (United Concordia);

Mike Cassidy (Siemens); Margarite Galloway (VIPS); Gerald Cimis (Alabama Medicaid); Dr. Ed Schooley (Delta Dental of Plan Iowa); Dr. Jerry Zackin (American Academy of Periodontology (AAP); Christine Farrell (MI Department of Health); Connie Briggs (Metlife); Penny Sanchez (EDS); Jeff Seybold (Deltanet); Sheila Frank (DDPA); Dawn Paine (Metlife); Brian Fitzgibbons (Metlife); Dr. Gordon Douglas (AAP); Tom Drinkard (Consultant); Dave Spinner (IL Medicaid); Kimberly Suda-Blake (AAP); Felecia Barrow (AL Medicaid); Laylani Williams (Louisiana Medicaid); Rose Hodges

Recorders: Elaine Parrish-Kuipers (DDPA), Christine Farrell

Chris Farrell volunteered to record minutes (be our scribe) for future conference calls.

Sheila Frank welcomed everyone to the call and to this new committee initiative.

Sheila noted that there was still a need for software vendors and more providers to join the workgroup. Participants were asked to forward the HL7 outreach letter and information to any interested parties. Website registration for HL7 was included in the outreach email. The facilitator for the group is Sheila Frank. The HL7 sponsor is Nancy Wilson-Ramon.

Sheila Frank, chair of the workgroup facilitated the kickoff call. Roll call was instituted. (I do not know names or companies of the participants). Chris Farrell (Michigan Medicaid) agreed to help Elaine Parrish with minutes. Chris will be the scribe for future meetings.

Structure, History & Status of Periodontal Attachments

Sheila noted that there was still a need for software vendors and providers to join the workgroup. Participants were asked to forward the email and information to any interested parties. Website registration for HL7 was included in the email.

Penny Sanchez, Co-chair for the HL7 Attachment workgroup gave an overview of the attachment process and the history. A powerpoint presentation was provided.

Penny noted that the attachment workgroup was trying to align the standards with HIPAA. The final rule on attachments has not been published. The expected NPRM (National Proposed Rule Making?) is August or September, 2004. The first round of attachments include 5-6 attachments that will be sent to HHS for approval. The periodontal attachment is not finished and hopefully it will be ready for the second round of attachments to be sent to HHS.

Penny Sanchez, Co-chair for the HL7 Attachment Special Interest Group (ASIG) gave an overview of the attachment development process and its history. A PowerPoint presentation was provided.

Penny noted that the attachment workgroup is trying to align the standards with HIPAA. No regulation on attachments has been published yet. The expected release date for a Notice of Proposed Rule Making (NPRM) is August or September, 2004. The first round of attachments developed by HL7 includes 6 attachments that were sent to HHS for approval. The periodontal attachment is not finished and may be included in the second round of attachments to be sent to HHS in the future.

Purpose

There was discussion about the role of the workgroup and whether the standards were for all dentists in the dental industry. There was a lot of concern expressed about periodontists, their clinical software and the periodontal charting forms that they use in their offices.

Discussion occurred about the role of the workgroup and if the standards were for all dentists in the dental industry. There was a lot of concern expressed about periodontists, their clinical software and the perio charting that they provide in their office.

Sheila and Penny both mentioned that tThe workgroup’s charge is to develop standards for an attachment to be sent via the provider’s billing system,system; it is not to replace their clinical records in their office. The standard is to define a list of data elements representing the minimum minimum with which a that a payer can ask formeet all their business needs,which will therebyand the define the maximum that a provider has will ever have to send to anythe payer for review and/or payment. This exercise is intended to provide specifications for a provider’s software vendor to build systems that seamlessly move information from the electronic charts of the future to the payers.

It will be years before it is mandated by law, if ever. Prior to regulation about the use of this standard, thereA future project of the workgroup would be pilot projects with software vendors to do testing of the attachment. That is why it is necessary to have software vendors and/or clearinghouses on the workgroup.

Other discussion focused on the current status of periodontal attachments. Two or three different payers methods are in use different methods for attachments. One use is a web board for perio charts and x-rays. Another noted thatSome attachments information can currently be found on the 837 in the NTE or PWK segments of the transaction. The stated goal of HL7 and X12 is to ultimately simplify the 837 claim transaction by have a separateremoving supporting clinical information from ittransaction from the 837 and placing it in separate attachment transactions. In order to do this, we need to define the attachment standards, and test them thoroughly before making any changes to the 837. . This workgroup is focused on the periodontal attachment. Other workgroups for scanning images, x-rays, written reports may be initiated at a later date.

It was explained that the same attachment standard may be used for prior authorization using a HIPAA compliant ASC X12 278 transaction. One code in the attachment would be changed to denote that it is a prior authorization request as opposed to a claim attachment.

History of Periodontal Attachment Development

Jeff Seybold of Denti-Cal provided the history of the periodontal attachment, California Medicaid’s business needs and the work that has been by the NMEH (National Medicaid Electronic Data Interchange HIPAA (NMEH) Dental Subworkgroup over the last 6 years. Over 40 states provided initial input into the draft template that was sent to participants prior to the call. There are 90,000 periodontal attachments submitted to Medicaid per year. Additionally, X12 participants commercial areas have also provided input such as X12,UCCI (United Concordia (UCCI?), and the ADA (American Dental Association (ADA) Standards Development Committee and the Delta Dental Plans Association have provided input.

Action

Each participant was asked to analyze the working draft periodontal attachment spreadsheet, to add additional elements or more explanation of items already listed. Workgroup members may wish to add pointers to published dental terminology or add further description of the data elements.

Participants are also to answer the questions for each element: 1) if the information is required all the time, 2) if it is required only part of the time and what are the conditions under which it would be required and 3) is it not required at all. The criteria for requiring each data element (procedure code) will help with the development of the final specifications. An extra column can be added to the chart to document the criteria.

Workgroup members were asked to have this ready for the next call, as we will review the chart item by item.

A discussion on whether or not we should spreadsheet item number 7, implants, will take place at a future call.

The charge to participants was to review the draft template and cross-walk the information that payers need to use to pay the claim or approve treatment. Elements that need to be added or deleted should be noted. Explanations need to be defined for the additional elements. That is one of the roles of HL7 is to provide the description for the data elements.

Participants are to ask questions: 1) if the information is required all the time, 2) if it is required only part of the time and when it would be required and 3) not at all. The questions will help with the development of the specifications for the final rule.

The calls will be scheduled on the 3rd Tuesday of every month from 1:30-3 pm EDT. It was announced that the The next call will be May 18, 2004 at 1:30 pm. Call-in information will be sent later.