© 2010, Data Interchange Standards Association The Designated Standard Maintenance Organizations...

© 2010, Data Interchange Standards Association

The Designated Standard Maintenance Organizations ProcessJuly 2010

© 2010, Data Interchange Standards Association 2

Overview

• What is the DSMO?

• What does this mean in English?

• How do I submit a change request?

• What happens next?

• Resources


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)


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)


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


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


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



• 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



• 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


Create a Log in ID


Identify the Request Type


Identify the Business Reason for the Change Request


Identify the Suggested Solution for the Change Request


Change Request Number Provided


Provide Additional Detail for X12 Transactions:

Other Implementation Guides Affected



Research Conducted



Specific Items Impacted in Implementation Guide



Other Health Care Areas Impacted



Requester Contact Information



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• 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

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 notified5th business day of the

Month

DSMO Members Opt-in (or out) within

10 business days

DSMO Members have 90-calendary days to

deliberate and develop recommendation for the

responseMay request additional

information from the requester during this time

One 45-day extension may be requested by any

DSMO Member

DSMO Members Review all recommended

responses Reach a disposition on the

DSMO CR Final Recommendation posted to the Web site

Requester is notified that the DSMO

recommendation has been posted

Requester has 15 calendar days to appeal

Yes No

Appeal Submitted?

DSMO CR is Final

Recommendation sent to SDO

Appeal Process

See slide 29

CRs Appeal

Remanded


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).



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.



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.



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.

DSMO Appeal Process


Appeal Process

Requester submits additional supporting

documentation on their appeal

Within 15 calendar days of Appeal declaration

deadline

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

Denied

Upheld

Remanded to DSMO

Members

CRs DeniedSlide 30

CRs UpheldSlide 31

CRs Appeal

Remanded Slide 24

One of threedecisions

DSMO Appeal Process: Appeal Denied


CRs Denied

Denied

Requester can file another CR with more

information

Requester can file comments in response

to a NPRM

No further action

by Requester

One of fouractions

Requester can discuss further with

NCVHS

NPRM = Notice of Proposed Rulemaking

DSMO Appeal Process: Appeal Upheld


CRs Upheld

Upheld

The DSMO will re-categorize the

Change Request and provide a new

recommendation

Final Recommendation sent to SDO


DSMO Appeal Process Response Categories

Appeal Outcome Available Soon

Appeal Withdrawn

Appeal Upheld

Appeal Denied

Appeal Remanded


Resources

• DSMO Web sitewww.hipaa-dsmo.org

• ASC X12 ADA DeCCwww.x12.org www.ada.org

• NCPDP NUBCwww.ncpdp.org www.nubc.org

• HL7 NUCCwww.hl7.org www.nucc.org

Resources: To Submit Change Requests via Mail

Transaction Type Mailing Address Facsimile Number

Retail Pharmacy Transactions

National Council for Prescription Drug Programs9240 East Raintree DriveScottsdale, AZ 85260-7518

(480) 767-1042

Attachment Booklets

Health Level Seven, Inc.3300 Washtenaw AvenueSuite 227Ann Arbor, MI 48104

(734) 677-6622

All Other Transactions

Washington Publishing Company10940 NE 33rd PlaceSuite 204Bellevue, WA 98004

(775) 239-2061


© 2010, Data Interchange Standards Association The Designated Standard Maintenance Organizations...

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