The Designated Standard Maintenance
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)
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)
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
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 just below
- Paper-based – reviewd at end of this page under resources
How do I submit a change request?
- 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
Figure 1 - Create a Log in ID Step 1
Figure 2 - Create a Log in ID Step 2
- Select request type
Figure 3 - Identify the Request Type
- Enter Business Reason for change
Figure 4 - Identify the Business Reason for the Change Request
- Provide suggested revision to address the change
Figure 5 - Identify the Suggested Solution for the Change Request
- Receive DSMO Change Request (DSMO CR) ID #
Figure 6 - Change Request Number Provided
• Identify additional guides that may be impacted by CR
- Complete questionnaire form (X12N requests)
Figure 7 - Other Implementation Guides Affected
• 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 any related DSMO CR numbers
Figure 8 - Research Conducted
• Identify version, key page numbers and sections of the guide
Figure 9 - Specific Items Impacted in Implementation Guide
• Identify any specific areas and/or specialties of health care impacted by the request
Figure 10 - Other Health Care Areas Impacted
• Provide Subject Matter Expert and Alternate Contact information
Figure 11 - Requester Contact Information
• Additional information regarding:
• X12 group participation
• X12 groups contacted
• Other industry groups contacted
• Information provided by any of the above
Figure 12 - Other Input Received
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
- DSMO members may request one 45-day extension
- Requester or DSMO member may submit an appeal to the DSMO response
DSMO Process Flow 90-day Batch Cycle
Figure 13 - 90-day Batch Cycle Flow
DSMO Response Categories
According to DHHS, necessary items include:
- Modifications necessary to permit compliance with the standard/law.
- Something in the adopted standard or implementation specification conflicts with the regulation.
- 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)
- A data element or code set that is critical to the industry's business process has been left out.
- There is a conflict among different adopted standards
- There is an internal conflict within a standard (implementation guide).
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.
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.
- 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.
- DHHS Policy.
Classified as items that require follow up by the Department of Health and Human Services in regards to the Final Rule.
- Withdrawn by Submitter.
Classified as items that have been removed from Change Request System consideration.
Classified as items where the DSMOs did not reach consensus on response and will follow the appeal process.
- Industry Comment Request Process.
Classified as items that require comments from the industry to determine consensus.
- 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).
- 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.
DSMO Appeal Process
Figure 14 - DSMO Appeal Process Flow
DSMO Appeal Process: Appeal Denied
Figure 15 - DSMO Appeal Process: Appeal Denied Flow
DSMO Appeal Process: Appeal Upheld
Figure 16 - DSMO Appeal Process: Appeal Upheld Flow
DSMO Appeal Process Response Categories
- Appeal Outcome Available Soon
- Appeal Withdrawn
- Appeal Upheld
- Appeal Denied
- Appeal Remanded
To Submit Change Requests via Mail or Fax
||Retail Pharmacy Transactions
||National Council for Prescription Drug Programs
240 East Raintree Drive
Scottsdale, AZ 85260-7518
||Health Level Seven, Inc.
3300 Washtenaw Avenue
Ann Arbor, MI 48104
||All Other Transactions
||Washington Publishing Company
10940 NE 33rd Place
Bellevue, WA 98004
Download the Presentation
The Designated Standards Maintenance Organizations (DSMO) have created a presentation "Understanding the HIPAA Processes" to provide information on the HIPAA transactions, code sets, and operating rules processes under HIPAA. The presentation was developed to satisfy an industry need to have in one concise document the process of how to request changes to HIPAA mandated standards.
The presentation is available at www.hipaa-dsmo.org/Main.asp or directly.
The DSMO includes three American National Standards Institute (ANSI) Accredited standard development organizations - Accredited Standards Committee (ASC) X12, Health Level Seven (HL7) International, and the National Council for Prescription Drug Programs (NCPDP), and three data content organizations, the American Dental Association (ADA) Dental Content Committee (DeCC), National Uniform Billing Committee (NUBC), and National Uniform Claim Committee (NUCC). The DSMO reviews change requests to the HIPAA designated standards and requests for new standards and code sets to be adopted.