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Back  RFI # 1949: THCIC TX Medicaid 2000BA/DMG05

Formal vs. Informal Help Informal Formal

Submitter

Kim Walker

Description

In reviewing the technical specification for this payer there is a requirement for the patient's race in 2010BA/CA-DMG05. An email from the payer states they are not considered a HIPAA covered entity: "THCIC is not a covered entity under HIPAA, therefore is not required to comply with HIPAA standard transactions. Health and Safety Code, §108.009(h) requires that we…collect the data in submission formats…developed by [ANSI] or its successor or other nationally accepted standardized forms. Section 108.009(k) also requires that we (DSHS) collect the racial and ethnic background of patients, although this is not part of the HIPAA compliant ANSI ASC X12N 837 Version 5010…Implementation Guides. Our contractor’s (System13, Inc.) system will allow you to submit the data without the race and ethnicity codes…The collection of [data] is required by Texas law and failure to report such information could result in an administrative action against the…facility."
Is this a valid request by the payer?

Submitter Assigned Keywords

DMG05 Race

Response

As you pointed out, the 2010BA/CA-DMG05 Composite Race or Ethnicity Information is Not Used in the Professional version X005010222A1 TR3. Therefore, any requirement that it be used is not compliant with the TR3. Whether an entity is or is not mandated under HIPAA or any other State or Federal legislative mandate is irrelevant to the compliant usage of any X12 published TR3.

Related to your question regarding requiring that this data be sent:

"Per the ASC X12 Intellectual Property Use (see http://store.x12.org/store/ip-use), inclusion of a requirement as described violates the Must Not provisions:

'Contradict, countermand or duplicate any requirement of the associated TR3'

and

Add, modify or delete any requirements, including loop, segment or element names, notes or rules, examples, appendix, or code list subsets from Section 2 of the associated TR3."

Recommendation

The 2300 K3 – File Information Situational usage rules read:

Situational Rule: Required when ALL of the following conditions are met:

• A regulatory agency concludes it must use the K3 to meet an emergency legislative requirement;
• The administering regulatory agency or other state organization has completed each one of the following steps:
contacted the X12N workgroup, requested a review of the K3 data requirement to ensure there is not an existing method within the implementation guide to meet this requirement
• X12N determines that there is no method to meet the requirement.
If not required by this implementation guide, do not send.

If a regulatory agency concludes it has a legislative requirement not met elsewhere in the TR3 the administering agency can request a review by the appropriate X12N Work Group for approval to use the K3 segment to meet this need.



The current K3 approval process is cited in the TR3 Notes of the K3 segment.
Submission 7/9/2014
Status Date 3/10/2015
Status F - Final
Primary References
Document 005010X222
Section2.4
Page128
Set ID837P
Table2
Loop2000BA
Segment Position0320
Segment IDDMG
Element Position5
Industry NameSubscriber Demographic Information