Transcript Presentation Title

The Designated Standard Maintenance Organizations Process
July 2010
© 2010, Data Interchange Standards Association
Overview
• What is the DSMO?
• What does this mean in English?
• How do I submit a change request?
• What happens next?
• Resources
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What is the DSMO?
• Designated Standard Maintenance Organizations (DSMO)
– Organizations named by the Secretary (HHS) under HIPAA in
§ 162.910(a) to
• Maintain standards adopted under HIPAA
• Receive and process requests to adopt new standards or modify existing
standards
– Member Organizations are standards development organizations
(SDOs) and data content committees
• Accredited Standards Committee (ASC) X12
• Dental Content Committee of the American Dental Association (DeCC)
• Health Level Seven (HL7)
• National Council for Prescription Drug Programs (NCPDP)
• National Uniform Billing Committee.(NUBC)
• National Uniform Claim Committee (NUCC)
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What is the DSMO?
• Process for modification of existing standards and
adoption of new standards must include:
– Open public access
– Coordination with other DSMOs
– An appeals process for each of the following, if dissatisfied with the
decision on the request:
• The requester of the proposed modification.
• A DSMO that participated in the review and analysis of the request for the
proposed modification, or the proposed new standard.
– Expedited process to address content needs identified within the
industry, if appropriate.
– Submission of the recommendation to the National Committee on
Vital and Health Statistics (NCVHS)
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What is the DSMO?
• Process details defined through a Memorandum of
Understanding (MOU)
• MOU defines Guiding Principles
– Public access (single point of entry)
– Timely review of change requests
– Cooperation and communication
– Consider all viewpoints
– Evaluate impact of change requests
– Maintain a national perspective
– Conform to legislation
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What does this mean in English?
• Public access portal for the submission of requests to:
– Modify existing standard transactions adopted under HIPAA
– Request new standard transactions for adoption under HIPAA
– e.g. new business need or data need
– e.g. data needs change from current transaction
• Submission via Web or Paper
– Web-based – reviewed in the following slides
– Paper-based – see resources at end of presentation
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How do I submit a change request?
• Web-based process
– Requester logs in to web site – requires creation of a login ID
• Captures name, email address and contact information
• Needed in the event that additional clarification of request is needed during the
review process
• Information available only to DSMO Secretary and Administrator
– EXCEPT for email address, which is viewable on the public Web site
– Nothing else distributed to DSMO members
• Communication with requester generally occurs through the DSMO Secretary
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How do I submit a change request?
• Step-by-step process
1. Select request type
2. Enter Business Reason for change
3. Provide suggested revision to address the change
4. Receive DSMO Change Request (DSMO CR) ID #
5. Complete questionnaire form (X12N requests)

Identify additional guides that may be impacted by CR

Provide information relative to previous change request
1.
CMS FAQs reviewed – Yes/No
2.
Existing DSMO CRs reviewed – Yes/No
3.
New request – Yes/No
4.
Provide and related DSMO CR numbers
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How do I submit a change request?
• Step-by-step process (continued)
5. Complete questionnaire form (X12N requests)

Identify version, key page numbers and sections of the guide

Identify any specific areas and/or specialties of health care impacted by the
request

Provide Subject Matter Expert and Alternate Contact information

Additional information regarding:

X12 group participation

X12 groups contacted

Other industry groups contacted

Information provided by any of the above
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Create a Log in ID
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Create a Log in ID
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Create a Log in ID
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Identify the Request Type
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Identify the Business Reason for the Change Request
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Identify the Suggested Solution for the Change Request
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Change Request Number Provided
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Provide Additional Detail for X12 Transactions:
Other Implementation
Guides Affected
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Provide Additional Detail for X12 Transactions:
Research Conducted
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Provide Additional Detail for X12 Transactions:
Specific Items Impacted in
Implementation Guide
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Provide Additional Detail for X12 Transactions:
Other Health Care Areas
Impacted
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Provide Additional Detail for X12 Transactions:
Requester Contact
Information
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Provide Additional Detail for X12 Transactions:
Other Input Received
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What happens next?
• DSMO Change Request Process
– Allows DSMO members to opt-in or opt-out of a change request
– Review Process generates batches on a monthly basis
– DSMO Review is a 90-day cycle
• Details on the following slides
– DSMO members may request one 45-day extension
• Details on the following slides
– Requester or DSMO member may submit an appeal to the DSMO
response
• Details on the following slides
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DSMO Process Flow 90-day Batch Cycle
Submitter enters Change
Request , receives ID #
(DSMO CR #)
Becomes part of the batch
created the next month
Monthly Batch created and
DSMO Members notified
5th business day of the
Month
DSMO Members Opt-in
(or out) within
10 business days
DSMO Members have 90calendary days to
deliberate and develop
recommendation for the
response
May request additional
information from the
requester during this time
One 45-day extension may
be requested by any
DSMO Member
Requester is notified that
the DSMO
recommendation has been
posted
Requester has 15 calendar
days to appeal
Appeal
Yes
Appeal
Process
See
slide 29
CRs
Appeal
Remanded
© 2010, Data Interchange Standards Association
DSMO Members Review
all recommended
responses
Reach a disposition on the
DSMO CR
Final Recommendation
posted to the Web site
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Submitted?
No
DSMO CR
is Final
Recommendation
sent to SDO
DSMO Response Categories
A. Modifications necessary to permit compliance with the
standard/law.
According to DHHS, necessary items include:
1.
Something in the adopted standard or implementation specification conflicts
with the regulation.
2.
A non-existent data element or code set is required by the standard.
(removal of data content that is not supported by the healthcare industry any
longer)
3.
A data element or code set that is critical to the industry's business process
has been left out.
4.
There is a conflict among different adopted standards
5.
There is an internal conflict within a standard (implementation guide).
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DSMO Response Categories
B. Modifications.
Classified as additions or deletions of data elements, internal
code list values, segments, loops; changes in usage of
segments, data elements, internal code list values; changes in
usage notes; changes in repeat counts; changes in formatting
notes or explanatory language that do not fall into Category A.
C. Maintenance.
Classified as items that do not impact the implementation of the
transaction. Items classified as Maintenance will require no
further DSMO actions. Items are to follow the SDO process.
D. No Change.
Classified as items that the implementation guides do meet the
needs requested, or did go through the consensus building
process originally to meet need. May request follow up by the
submitter for further action.
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DSMO Response Categories
E. DHHS Policy.
Classified as items that require follow up by the Department of
Health and Human Services in regards to the Final Rule.
F. Withdrawn by Submitter.
Classified as items that have been removed from Change
Request System consideration.
G. Appeal.
Classified as items where the DSMOs did not reach consensus
on response and will follow the appeal process.
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DSMO Response Categories
H. Industry Comment Request Process.
Classified as items that require comments from the industry to
determine consensus.
I.
Recommendation for adoption of new/modified HIPAA
standard.
Classified as items that result in the recommendation to the
National Committee on Vital and Health Statistics for the
adoption of a new/modified HIPAA standard. Examples might
include a request for a new transaction, or a new version or
release of an already-named standard for a given transaction(s).
J. Out of DSMO Scope.
Classified as items that are not in the scope of the DSMO. An
example is change requests for modifications to transactions not
named in HIPAA.
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DSMO Appeal Process
Appeal
Process
Requester submits
additional supporting
documentation on their
appeal
Within 15 calendar days
of Appeal declaration
deadline
Denied
Slide 30
DSMO Members
deliberates appeal using
additional information
submitted
Reaches disposition on
the appeal within
30 calendar days
Requester is notified of
the final DSMO
recommendation
© 2010, Data Interchange Standards Association
CRs
Denied
Upheld
CRs
Upheld
Slide 31
One of three
decisions
Remanded to
DSMO
Members
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CRs
Appeal
Remanded
Slide 24
DSMO Appeal Process: Appeal Denied
CRs
Denied
Requester can file
another CR with more
information
Requester can file
comments in response
to a NPRM
Denied
One of four
actions
Requester can discuss
further with
NCVHS
No further
action
by Requester
NPRM = Notice of Proposed Rulemaking
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DSMO Appeal Process: Appeal Upheld
CRs
Upheld
Upheld
© 2010, Data Interchange Standards Association
The DSMO will
re-categorize the
Change Request and
provide a new
recommendation
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Final Recommendation
sent to SDO
DSMO Appeal Process Response Categories
Appeal Outcome Available Soon
Appeal Withdrawn
Appeal Upheld
Appeal Denied
Appeal Remanded
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Resources
• DSMO Web site
www.hipaa-dsmo.org
• ASC X12
www.x12.org
ADA DeCC
www.ada.org
• NCPDP
www.ncpdp.org
NUBC
www.nubc.org
• HL7
www.hl7.org
NUCC
www.nucc.org
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Resources: To Submit Change Requests via Mail
Transaction Type
Mailing Address
Facsimile Number
Retail Pharmacy
Transactions
National Council for Prescription
Drug Programs
9240 East Raintree Drive
Scottsdale, AZ 85260-7518
(480) 767-1042
Attachment
Booklets
Health Level Seven, Inc.
3300 Washtenaw Avenue
Suite 227
Ann Arbor, MI 48104
(734) 677-6622
All Other
Transactions
Washington Publishing Company
10940 NE 33rd Place
Suite 204
Bellevue, WA 98004
(775) 239-2061
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