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FUTURE OF HEALTHCARE EDI
A brief overview of what lies ahead after 5010
July 2017
2
INTRODUCTION
The Accredited Standards Committee X12
(ASC X12) has continuously worked to-
wards updating the EDIs as a part of their
normal development standards. These up-
dates shall be implemented into common
use only after the Department of Health
and Human Services (HHS) adopts them as
the Health Insurance Portability and Ac-
countability Act of 1996 (HIPAA) standard
through regulation. The Version 5010 was
once such last adaptation from HIPAA
which is currently still in use.
The ASC X12 Insurance Subcommittee
(ASC X12N) transactions was working on a
subsequent Version 006020 (‘6020’). This
version was developed and released for
public comment, but was not brought for-
ward for adoption under HIPAA. ASC X12N
is currently working on the next version of
transactions which is 7030. Version 6020
will be the starting point for the 7030 ver-
sion and will be updated to reflect new
requirements for transactions.
WHAT HAPPENED TO 6020?
ASC X12 Insurance Subcommittee created
the 6020 Guides and Emdeon (now
Change Healthcare) executed a pilot pro-
gram in September 2013. During the pilot,
Critical errors were found in the TR3s and
Change Requests were submitted to ASC
X12. The nature of these observations was
critical enough to discourage the publica-
tion of these. As a result, an attempt has
been made to plug those deficiencies in
the new version.
This is 7030.
WELCOME TO 7030!
The ASC X12 Insurance Subcommittee is
currently working on the HIPAA-adopted
transactions sets 7030, and its in the public
comment period with 4 Cycles completed
as of July 2017 and Cycles 5 & 6 are
scheduled between September through
November 2017.
The public comment periods for the TR3s
(Type 3 Technical Reports) are being sort-
ed in 8 staggered cycles, each cycle has a
set of EDI transactions that are run for the
public comment period between a given
timeframe. In the following page, is one
such example of the Cycle 4 comment pe-
riod between Feb to June 2017.
Future of Healthcare EDI
3
Cycle 4: February 1 - June 1, 2017
Health Care Claim: Professional (837P)
Health Care Claim: Institutional (837I)
Health Care Claim: Dental (837D)
Health Care Service: Data Reporting (837R)
Furthermore on the right is the figure depicting
how the comment period has been planned for
the 7030.
There has been a significant update on
the original scheduled comment period
and there could be more changes on
these timelines.
Future of Healthcare EDI
4
Nalashaa Solutions
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meaningful insights and in exceeding your expec-
tations. Our clarity of thought has earned us
many laurels in this fast paced world where
healthcare technology advancements are rolling
out continuously.
Call Us: 732-602-2560 Ext:200
Email Us: info@nalashaa.com
Visit Us: www.nalashaa.com
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Future of Healthcare EDI

  • 1. FUTURE OF HEALTHCARE EDI A brief overview of what lies ahead after 5010 July 2017
  • 2. 2 INTRODUCTION The Accredited Standards Committee X12 (ASC X12) has continuously worked to- wards updating the EDIs as a part of their normal development standards. These up- dates shall be implemented into common use only after the Department of Health and Human Services (HHS) adopts them as the Health Insurance Portability and Ac- countability Act of 1996 (HIPAA) standard through regulation. The Version 5010 was once such last adaptation from HIPAA which is currently still in use. The ASC X12 Insurance Subcommittee (ASC X12N) transactions was working on a subsequent Version 006020 (‘6020’). This version was developed and released for public comment, but was not brought for- ward for adoption under HIPAA. ASC X12N is currently working on the next version of transactions which is 7030. Version 6020 will be the starting point for the 7030 ver- sion and will be updated to reflect new requirements for transactions. WHAT HAPPENED TO 6020? ASC X12 Insurance Subcommittee created the 6020 Guides and Emdeon (now Change Healthcare) executed a pilot pro- gram in September 2013. During the pilot, Critical errors were found in the TR3s and Change Requests were submitted to ASC X12. The nature of these observations was critical enough to discourage the publica- tion of these. As a result, an attempt has been made to plug those deficiencies in the new version. This is 7030. WELCOME TO 7030! The ASC X12 Insurance Subcommittee is currently working on the HIPAA-adopted transactions sets 7030, and its in the public comment period with 4 Cycles completed as of July 2017 and Cycles 5 & 6 are scheduled between September through November 2017. The public comment periods for the TR3s (Type 3 Technical Reports) are being sort- ed in 8 staggered cycles, each cycle has a set of EDI transactions that are run for the public comment period between a given timeframe. In the following page, is one such example of the Cycle 4 comment pe- riod between Feb to June 2017. Future of Healthcare EDI
  • 3. 3 Cycle 4: February 1 - June 1, 2017 Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) Health Care Claim: Dental (837D) Health Care Service: Data Reporting (837R) Furthermore on the right is the figure depicting how the comment period has been planned for the 7030. There has been a significant update on the original scheduled comment period and there could be more changes on these timelines. Future of Healthcare EDI
  • 4. 4 Nalashaa Solutions Nalashaa believes in simple solutions to derive meaningful insights and in exceeding your expec- tations. Our clarity of thought has earned us many laurels in this fast paced world where healthcare technology advancements are rolling out continuously. Call Us: 732-602-2560 Ext:200 Email Us: info@nalashaa.com Visit Us: www.nalashaa.com Continue reading? Please fill the form to the right.