Become a Member

Adopting Standards for Encounter Data Systems

What standard applies to my application?

  • Chase the data source for your application and the applicable data standards associated with that data source.

Why was the ANSI ASC X12 837 claim / encounter standard selected for the Heath Care Service Data Reporting Guide?

  • State discharge data systems have been identified as a potential user because most use the UB data content as their data source and the information systems that support UB data collection are mandated to use ANSI ASC X12 837 claim / encounter standard mandated by HIPAA.
  • Medicaid Managed Care reporting uses encounter reporting that uses UB data specifications as its primary data source and consequently the ANSI ASC X12 837 claim / encounter standard.
  • It should be noted that the UB-04 is the most current version of UB data content. This version replaced the UB-92.

What steps are necessary to adopt an ANSI ASC X12 837 claim / encounter standard and/or implementation of that standard?

  • Familiarize yourself with the ANSI ASC X12 standard process. (See the ANSI ASC X12 Glossary document)
  • Familiarize yourself with the ANSI ASC X12 837 claim / encounter standard. (See the 837 101 Tutorial document)
  • Compare your current data requirements to those in the appropriate standard. (See Gap Analysis Guideline document)
  • Decide on the need for unsupported data.
    • Is the unsupported data really necessary?
    • If so, can the unsupported data be derived from existing data in the standard?
    • If not, proceed with process to change the standard
  • If necessary, proceed with process to change the ANSI ASC X12 standard and/or implementation guide. (See the ANSI ASC X12 Change Process 101 document)
  • If necessary, proceed with process to change the appropriate external code source by identifying the organization that is responsible for maintaining that external code source and following the necessary change protocol defined by that organization. (See External Code Maintenance List)
  • Educate potential users of the standard on implementation issues. (See Consortium Educational Strategy Document)
  • Test application using the WEDI SNIP recommendations for testing X12 transactions. (http://snip.wedi.org/public/articles/testing030901.pdf)
  • Use and publish data that is collected. This data is used for a variety of purposes both federally and by states. A good resource to find out more about federal use of the data would be the Agency for Healthcare Research and Quality (www.ahrq.gov) and their Healthcare Cost and Utilization Project (HCUP). A good resource for finding out more about state use of the data would be the National Association of Health Association of Health Data Organizations (www.nahdo.org).