I'm looking to find out if there are already any standards out there for storing/transmitting healthcare claim data (HCFA/CMS 1500, UB92, UB02, etc) through an XML format. I know of the official standards for X12 and ANSI-837 4010 but I'm looking for something a little less complex and before rolling our own I'd like to see if there is something else out there already built.
A:
Are you aware of HL7? It's not XML but it's another healthcare standard.
Instead of worrying about complexity, invest in smart tools.
Bryan Oakley
2010-08-06 15:51:26
I'm aware of HL7 but have not looked into the specifics of the format. The smart tools do little to mask the complexity of the format and I have so far not seen a good ROI on the expense of them. I could be wrong here we are still looking that direction.
Nathan Palmer
2010-08-06 15:58:54
A:
http://docs.sun.com/app/docs/doc/820-1279?l=en
The Oracle/Sun product is quite nice for translating between the X12 format and XML. Yes, it's commercial.
http://www.ibm.com/developerworks/data/library/dmmag/DMMag_2009_Issue2/Industry/index.html
S.Lott
2010-08-06 19:47:07
A:
The easy answer is that what standard you use depends on how you and the entity that you are sending data to, or receiving data from, are covered by HIPPA.
http://aspe.hhs.gov/admnsimp/pl104191.htm#1176
This is probably far from the answer you want, but X12 is THE required standard for transmission of healthcare claim data, at least as far as HIPPA is concerned. Also, requirements of specific transaction data labeling differ from state to state and agency to agency, though this is being consolidated. Check with the receiving entity on their specific requirements.
As for XML, you can embed HL7 XML data in the X12N data, if that's what you are looking for.
This is state specific but you might want to look at this
http://www.acbhcs.org/HIPAA/Resources/CMS%20Data%20Content%20and%20Code%20Sets.pdf
Jay Woods
2010-08-12 15:49:07