January 1997
Introduction 2
Acknowledgments 4
Health Claims or Equivalent Encounter Information 6
Accredited Standards Committee (ASC) X12, Health Care Task Group 6
ASC X12N Health Care Claim (837) 8
ASC X12N Interactive Healthcare Claim/Encounter (IHCLME) 12
National Council for Prescription Drug Programs (NCPDP) 16
NCPDP Standard Claims Billing Version 2.0 16
NCPDP Telecommunications Standard Format Version 3.2 17
Health Care Financing Administration (HCFA) 24
HCFA National Standard Format (NSF), Version 002.00 25
HCFA Uniform Bill-92 (UB-92), Version 4.1 28
American Dental Association (ADA) Accredited Standards Committee MD 156 31
ADA Implementation Guide for ASC X12 837 33
Health Level Seven, Inc. (HL7) 35
Health Level Seven Versions 1.0 through 3.0 36
National Uniform Claim Committee (NUCC) 60
National Uniform Claim Committee Recommended Data Set for a Non-Institutional Claim or Encounter 62
Health Claim Attachments 63
Accredited Standards Committee (ASC) X12 Insurance Subcommittee, Health Care Task Group. 64
ASC X12 Patient Information (275) 65
IEEE 1157 MEDIX Project 70
IEEE 1073, Standard for Medical Device Communications 71
Digital Imaging Communication in Medicine (DICOM) Standards Committee 77
DICOM Standard. NEMA PS3.x - 1992, 1993, 1995 78
ASTM Committee E31 on Healthcare Informatics 81
ASTM E1384-96 Standard Guide for Content and Structure of the Computer-Based Patient Record 82
ASTM E1769-95 Standard Guide for Properties of Electronic Health Records and Record Systems 85
ASTM E1633-95 Standard Specification for Coded Values Used in the Computer-Based Patient Record 87
Enrollment and Disenrollment in a Health Plan 90
Accredited Standards Committee (ASC) X12, Health Care Task Group 90
ASC X12 Benefit Enrollment and Maintenance (834) 90
National Council for Prescription Drug Programs (NCPDP) 94
NCPDP Member Enrollment Standard 94
Eligibility for a Health Plan 95
Accredited Standards Committee X12 Insurance Subcommittee, Health Care Task Group 95
ASC X12, Health Care Eligibility/Benefit Inquiry (270) 96
ASC X12, Health Care Eligibility/Benefit Information (271) 96
ASC X12, Health Care Task Group 100
Interactive Health Care Eligibility/Benefit Inquiry (IHCEBI) 100
Interactive Health Care Eligibility/Benefit Response (IHCEBR) 100
Health Care Payment and Remittance Advice 104
Accredited Standards Committee X12 Insurance Subcommittee, Health Care Task Group 104
ASC X12N Health Care Claim Payment/Advice (835). 104
Health Care Premium Payments 108
Accredited Standards Committee X12 Insurance Subcommittee, Health Care Task Group 108
Consolidated Service Invoice/Statement (811) 108
Payment Order/Remittance Advice (820) 108
First Report of Injury: 112
Accredited Standards Committee X12 Insurance Subcommittee, Property And Casualty Task Group 112
Report of Injury, Illness or Incident (148) 113
Health Level Seven (HL7) 117
ASTM Committee E31 on Healthcare Informatics 118
E1744-95, Standard Guide for a View of Emergency Medical Care in the Computerized Patient Record 118
Health Claim Status 121
Accredited Standards Committee X12 Insurance Subcommittee, Property and Casualty Task Group 121
Health Care Claim Status Request (276) 121
Health Care Claim Status Notification (277) 121
Referral Certification and Authorization 126
Accredited Standards Committee X12 Insurance Subcommittee, Property and Casualty Task Group 126
Health Care Service Review Information (278) 127
Codes and Code Sets (including issues of maintenance) 132
World Health Organization (WHO) 132
International Classification of Diseases, Ninth Revision (ICD-9) 132
International Classification of Diseases, Tenth Revision (ICD-10) 132
National Center for Health Statistics (NCHS) 133
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 133
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) 133
International Classification of Diseases Procedure Coding System (ICD-10-PCS) 133
American Medical Association (AMA) 138
Physicians' Current Procedural Terminology (CPT) 138
College of American Pathologists 141
Systematized Nomenclature of Human and Veterinary Medicine (SNOMED) International: 141
American Dental Association (ADA) 144
Current Dental Terminology (CDT) 144
Advisory Committee on Dental Electronic Nomenclature Indexing and Classification (ACODENIC) 146
Microglossary of SNOMED for Dentistry 146
Center for Nursing Classification, University of Iowa College of Nursing 147
Nursing Interventions Classification (NIC) 147
International Conference on Harmonization 150
International Medical Terminology (IMT) 150
Health Care Claim Adjustment Reason Code/Health Care Claim Status Code Committee 155
Health Care Claim Adjustment Reason Codes 155
Health Care Claim Status Codes 158
Logical Observation Identifier Names and Codes (LOINC) Consortium 160
Logical Observation Identifier Names and Codes (LOINC) 160
Georgetown University Home Care Project 165
Home Health Care Classification (HHCC) System 165
Perspective on Code Sets Within Transaction Standards 167
Unique Identifiers (including allowed uses) 169
Individuals 171
Employers 178
Health Plans 179
Health Care Providers 180
Security, Safeguards and Electronic Signatures 185
ACR NEMA / DICOM 187
Accredited Standards Committee (ASC) X12 188
ASTM 190
Computer-based Patient Record Institute (CPRI) 193
CEN TC251 Working Group 6 on Security, Privacy, Quality and Safety 194
Health Level Seven (HL-7) 196
IEEE 197
National Council for Prescription Drug Programs (NCPDP) 198
Low Cost Distribution Mechanism 199
Template for Transaction Standards 201
Template for Frameworks, Architectures and Models 204
Appendix B, Activities to promote inter-operability 206
Frameworks/Architectures and Models: 206
IEEE P1157.1 -Joint Working Group for a Common Data Model 206
Health Level 7 Reference Information Model 212
HL7 Version 3 Message Development Framework 214
American Dental Association (ADA) Computer-Based Oral Health Record 217
Other 222
CPRI Computer-based Patient Record Description of Content 222
CPRI Project Evaluation Criteria 227
CPRI Computer-based Patient Record System Description of Functionality 232
Wright State University College of Nursing and Health 240
ASTM E1460-92 247