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Where to find the workbook and supporting 278 TR3.

The DRAFT FHIR to X12 (X12 to FHIR) mapping workbook and access to the X12N 005010x271 278 Health Care Services Review and Response Technical Report 3 (TR3) can be found here:  http://store.x12.org/store/limited-development-license

Please read through the X12 Limited Development Use License Agreement (a snippet of which is show below).

After reading the License Agreement, click on purchase . Please note the amount will be $0.00.

 

Notes about the workbook:

The workbook contains the following tabs:

Disclaimer

This tab is a reminder that there is IP involved in what we are doing AND that the mapping in other tabs is DRAFT!!! YES, it is DRAFT and subject to weekly changes.

Claim Mapping

This tab is a listing of the FHIR Resource “Claim” to the corresponding X12 5010 278x215

Column Headings

FHIR REQUEST DATA ELEMENT. The list (generally in order) of the Message being sent.

VALUE. Listed here could be a value OR a Resource to be used. If a Resource is indicated, the mapping will be located lower in the spreadsheet.

X278 DATA ELEMENT. Brief indication of the X12 278 data element.

X12 VALUE SET. The X12 Code Set that will be referenced in the final IG/profiles.

  • NOTE: as there is a mistake in row 13, FHIR REQUEST DATA ELEMENT Claim.type. The X12 VALUE SET

NOTES

COLOR CODING:  The brown/orange boxes indicates those cells that were updated in the last two weeks.  The bright yellow indicates something that we are in discussion and could change. Darker yellow/tan with the words “TESTING/PILOT NOTE” mean we need feedback from the business.

X278 Request Field Listing

A listing of the 278 Request mapped to the FHIR Claim resource.

ClaimResponse Mapping

A listing of the 278-response mapped to the FHIR ClaimResponse resource

COLOR CODING: The brown/orange boxes indicates those cells that were updated in the last two weeks. Bright yellow, mapping team needs to complete. Blue, the rows were out of order and corrected. See row 25 & 35.

Value Sets

The X12 Value sets that will be used and mapped, in some instances to an existing FHIR value set, in others a new naming system/value set will be created and point back to the appropriate X12 value set.

HCR03

An example of an existing industry code set that will need a naming system created.

 

 

NOTED   UPDATES NEEDED:

Claim Mapping Tab, ROW 13, X12 VALUE SET.

  • FHIR REQUEST DATA ELEMENT Claim.type. The X12 VALUE SET column should not contain Claim Type, it should be blank. The (FHIR) VALUE column should contain: Institutional, Oral, Pharmacy, Professional, Vision and then the mapping to the X12 UM01 values should appear in the NOTES column. (The challenge identified is that the UM Segment is required at the 2000E level but can be overridden at the 2000F. Need to complete the code/value mapping.)

 

Claim Mapping Tab, ROW 66, X12 VALUE SET. See above. This is the 2000F UM01. Code set mapping needed.

 

X278Request Field Listing.

  • SV2 segment is shown as N/A. We have confirmation from payers that this mapping is needed.

 

 

Questions or updates needed to the spreadsheet that are a result of the connectathon:

Immediate need

eMail the following individuals with “PAS CONNECTATHON” as the subject line:

rdieterle@enablecare.us; pknapp@pknapp.com;jean@duteaudesign.com;MaryKay.McDaniel@cognosante.com

 

Suggestions or clarifications requested

Please leave note here:  https://confluence.hl7.org/display/FHIR/2020-01+Prior+Authorizations+Mapping+Updates