ASC X12 Special Appointed Committee PACDR Update - November 2011
For those of you following the APCD data standards activity, the ASC X12 Special Appointed Committee (SAC) for the Post Adjudicated Claims Data Reporting (PACDR) has been working hard.
The SAC, which includes representatives of ASC X12, states, carriers, Medicare, and other stakeholders, has been meeting weekly since mid-October to review the X12 standards in preparation for development of the PACDR guides.
The progress to date includes:
- The SAC completed "the first pass" review of the data elements on the 837 Institutional claim to determine the appropriate source of the data (claim versus payer reference files
- SAC co-chairs are working on:
- Assembling a list of remaining action items ("parking lot issues") for the review of the 837 Institutional
- Applying decisions made about the 837 Institutional data elements to the 837 Professional and Dental transactions; the Professional and Dental will be reviewed in future PACDR SAC meetings
- Marking up a draft version of the PACDR Institutional guide (based on review to date
- Drafting a standard set of situational rules to indicate when the data element should be populated from the claim and when it should be populated from the payer reference files
- situational rules will also be developed for APCD versus encounter reporting (e.g. Medicare, Medicaid). Drafts of situational rules will be reviewed in future PACDR SAC meetings
Reminder: The purpose of the group is to address for common, yet distinct, business processes.
- Medicaid Managed Care Encounter Reporting
- Medicare Advantage Encounter Reporting
- All Payer Claims Databases (APCD)
- Health Insurance Exchange paid claim data collection (may or may not be shared APCD)
The SAC will continue to meet until late January when the drafts will be brought to the X12 standing meeting in Tampa.
It is critical to have participation NOW to develop the best drafts of the guides.
If you are not currently participating, but would like to be involved, please contact: email@example.com, and include "PACDR" in the subject line.