Falls Church, VA, March 15, 2011 – Accredited Standards Committee X12 (ASC X12) announced today that the ASC X12 Health Care Claim Payment/Advice Reference Model Technical Report Type 2 (TR2) is available for industry review. This technical report contains operating rules developed by the X12N Operating Rules Committee, which operates under the Insurance Subcommittee (ASC X12N). Both the committee and the TR2 were created to address the operating rules requirements set forth in the Patient Protection and Affordable Care Act (PPACA).

“ASC X12 is committed to providing the industries we support, including the health care industry, with the detailed and explicit instructions needed to support consistent and effective electronic exchanges,” said Cathy Sheppard, ASC X12 Chair. “Producing Operating Rules that complement the underlying ASC X12 transmissions and support standardized business processing is an important part of that commitment.”
This draft technical report contains proposed operating rules for the Health Care Claim Payment/Advice (835) transaction, as implemented in ASC X12 Technical Report Type 3 (TR3) version 005010 (005010X221 with Errata), and the Electronic Funds Transfer, as it relates to the 835 transaction. The operating rules defined in the TR2 will apply to the 005010 version of the 835 TR3, as well as subsequent versions.

The initial intent of ASC X12 Implementation Guides was to standardize the transaction formats while still permitting variability supporting common health care industry practices. After using these mandated ASC X12 Implementation Guides for a period of time, the health care industry finds it necessary to increase the standardization of health care industry practices, thereby decreasing the variability accommodated in the Implementation Guides. This additional standardization is being accomplished through Operating Rules, which are complimentary to the information presented in the associated Implementation Guide. ASC X12 has been selected as the source of many HIPAA transactions by the Secretary of Health and Human Services, and ASC X12’s transactions have been used widely in the health care industry for well over 30 years. ASC X12 members have a depth of knowledge related to the business and the technical requirements around these transactions, making ASC X12 the ideal organization to develop operating rules related to the ASC X12 Implementation Guides.

The public review period will commence March 15, 2011 and will close on April 15, 2011 at 5:00 PM eastern time.

The X12N Operating Rules Committee will consider all comments submitted during the public review period. Official responses will be posted to the on-line conference at least 15 days prior to the corresponding Informational Forum. The posted response is not necessarily the final determination. Additional discussion in the Informational Forum may result in the X12N Operating Rules Committee approving a modification to the posted response. Such modifications are not posted to the on-line conference.

This is the only public review period prior to publication by ASC X12. For a complete understanding of changes being suggested and/or made to the technical report, reviewers should monitor the on-line conference during the public review period and consider all comments and responses prior to the Informational Forum.

Watch for the announcement of the corresponding Informational Forum. The Information Forum is the final opportunity to comment on modifications based on the public review period comments.

The draft technical report is available for download at: http://store.x12.org/or

Comments on the draft technical report can be submitted via the on-line conference at: http://store.x12.org/or/comments

About ASC X12
ASC X12, chartered by the American National Standards Institute more than 30 years ago, develops and maintains EDI and CICA standards along with XML schemas which drive business processes globally. The diverse membership of ASC X12 includes technologists and business process experts, encompassing health care, insurance, transportation, finance, government, supply chain and other industries. For additional information, visit www.x12.org.

For additional information: www.x12.org
Email: chair@x12.org