WEDI Foundation and Empire Medicare Services to Conduct Electronic Claim Attachment Pilot

August 25, 2004: The Centers for Medicare & Medicaid Services (CMS) has approved funding for a proposal by the Workgroup for Electronic Data Interchange (WEDI) Foundation and Empire Medicare Services to conduct a pilot of the electronic claim attachment. The WEDI Foundation will be the project administrator for the pilot. Empire Medicare Services, as a fee-for-service Medicare contractor, will work with selected electronic submitters to demonstrate the use of the electronic attachments between a health plan and several providers of varying sizes and technical capabilities. The pilot will use the X12N/HL7 recommended approach for claim attachments: the X12 275 and 277 transactions, the HL7 CDA-based attachment specifications and LOINC® codes.

This pilot project will provide an analysis of the implementation issues facing the health plan and the provider, including outreach/training, claim adjudication system integration, clinical-administrative system integration, and workflow/process adaptations. The pilot will also assess the impact on claims payments, including a comparison to transactions handled with paper notifications and paper attachments, and document any early benefits of the newly automated processes. WEDI and Empire Medicare Services will also share the results of this important pilot project with the industry and with CMS.

WEDI is one of the organizations named in the original 1996 HIPAA legislation, PL 104-91, with which the Secretary will consult on issues related to compliance with the standards considered or established under HIPAA. Empire Medicare Services is under contract to CMS as a Medicare fiscal intermediary and carrier.

Page Last Modified: 03/21/06