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Back  RFI # 2213: NY NoFault Data

Formal vs. Informal Help Informal Formal

Submitter

Chip Evelsizer

Description

The state of New York is considering future electronic healthcare data exchange mandates for No Fault insurance. The current paper based rules (PIP REG68) require some data related to bills (see NF3, NF4, NF5) must be exchanged that are not supported in the 5010 837 transactions. State mandated data values not currently supported in the TR3s typically use the K3 segment as a temporary solution.

Examples of 25+ NY specific data values include: Patient occupation, Previous similar condition, Condition solely result of auto accident, Injury result in disfigurement or perm disability, Rehab or Occu Therapy required, Provider Recommendation, Total Charges to Date…

What method would X12 recommend to send all of the New York required data values that are not currently supported in the 5010 TR3’s for voluntary exchanges prior to an electronic mandate? Would that method change if and when the data requirements are mandated by law to be sent electronically?

Submitter Assigned Keywords

K3 NoFault PIP New York

Response

From the information provided, it does not appear that these business data needs are addressed in the version 5010 837 TR3’s.

Recommendation

The version 5010 837 transaction sets contain K3 - File Information segments which are intended to address emergency legislative and regulatory requirements that involve business needs not addressed elsewhere in the transaction. 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.

That review process begins with the regulatory agency submitting a Change Request at http://changerequest.x12.org/. The legislative or regulatory requirements must be clearly defined within the request. The documentation submitted must demonstrate there is no other available option in the ASC X12N transaction that will meet the legislative or regulatory requirements.

Once the Change Request is received, X12 will do the following:

Confirm that the proposed use of the K3 is appropriate.

Create the business requirements for the appropriate business function related to the legislative or regulatory requirement.

Review the proposed formatting of the information to be included in the K3.

Review the approved temporary usage(s) of the K3 Segment to develop a permanent change to include the business case in future transaction implementation.

Post and process a Request for Interpretation (RFI) to the ASC X12 Interpretation Portal at http://www.x12.org/x12org/subcommittees/x12rfi.cfm explaining the use and format of the K3 segment.

Develop a permanent solution to include the business case in future transaction implementations.

Submission 5/15/2017
Status Date 7/11/2017
Status F - Final
Primary References
Document 005010X223A1
Section2.4