Final Agenda


Subcommittee on Standards

Hearing on HIPAA and ACA Administrative Simplification
–Operating Rules, ICD-10, Health Plan ID, Pharmacy Prior Authorization–

Hubert H. Humphrey Building
Department of Health & Human Services
200 Independence Ave, SW, Room 705-A
Washington, DC 20201

Wednesday, February 19, 2014


Printable Agenda, Purpose & Background Questions


Hearing Purposes, Objectives

The purpose of this hearing is to review and discuss the current status of selected administrative simplification topics that are a priority for NCVHS in 2014.

The objectives of this hearing are as follows:

  • Review the status of development of Operating Rules for all remaining HIPAA transactions (Claims, Enrollment, Premium Payment, Prior Authorization, Claims Attachments)
  • Discuss the status of initial implementation of Operating Rules for EFT/ERA, which began January 1, 2014
  • Review and discuss ICD-10 transition and implementation
  • Discuss use of ICD-10 in Workers’ Compensation, Property/Casualty and other non-covered entities
  • Review plans for enumerating and use of Health Plan ID
  • Review recommendations from DSMO regarding Pharmacy Prior Authorization Standard

9:00 – 9:15 am Welcome and Introductions Standards Subcommittee Co-Chairs
Walter Suarez and Ob Soonthornsima
9:15 – 10:45 am PANEL 1 – Review of Status Operating Rules
EFT/ERA Implementation; ORs for Remaining HIPAA Transactions

  • Operating Rules Authoring Entity
  • EFT Standards Authoring Entity
  • Other Payment Methods
  • Provider Perspective
  • Payer Perspectives
  • Banking Perspective
Gwen Lohse, CAQH
Janet Estep, NACHA
Heather McComas, AMA
Rob Tennant, MGMA
Janet Jackson, BCBSNC
Stuart Hanson, Citibank
10:45 – 11:00 am BREAK
11:00 – 12:30 pm PANEL 2 – ICD-10: Achieving a Successful Transition

  • CMS OESS Update
  • Medicare FFS
  • Medicaid
  • WEDI
  • Health Plans
  • Providers
  • Clearinghouses, Vendors
Matthew Albright, CMS, OESS
John Evangelist, CMS
Godwin Odia, CMS (via phone)
Jim Daley, WEDI
Sid Hebert, Humana
Rob Tennant, MGMA
Nancy Spector, AMA
George Arges, AHA
Meryl Bloomrosen, AHIMA
Jill Venskytis, PAHCOM
Debbie Meisner, Emdeon
Tim McMullen, Coop. Exchnage
12:30 – 1:15 pm LUNCH
1:15 – 2:15 pm PANEL 3 – ICD-10 Implementation Beyond Covered Entities

  • WEDI P&C eBilling Workgroup
  • Property/Property/Casualty Representative
  • Third Party Administrators
Sherry Wilson, Jopari Solutions Tina Greene, Mitchell Intl.
Don St Jacques, Jopari Solutions
Robert Holden, AAPAN
2:15 – 3:15 pm PANEL 4 – Pharmacy Prior Authorization

  • DSMO Recommendations
  • Industry Work Perspective
  • NCPDP Persepctive
  • Provider/Prescriber Perspective
  • CMS Perspective
Margaret Weiker, DSMO (via phone)
Tony Schueth, POCP
Lynne Gilbertson, NCPDP

Heather McComas, AMA
Andrew Morgan, OESS
3:15 – 3:30 pm BREAK
3:30 – 4:45 pm PANEL 5 – Health Plan ID Planning and Implementation Issues

  • HPID Introduction
  • WEDI Recommendations
  • Health Plan Perspective
  • Provider Perspectives
  • SDO Perspectives


Matthew Albright, OESS
Chevell Thomas, OESSLaurie Darst
Gail Kocher, BCBSA
Rob Tennant, MGMA
Margaret Weiker, ASC X12 (via phone)
Laurie Burckhardt, ASC X12 (via phone)

Lynne Gilbertson, NCPDP


4:45 – 5:00 pm Public Comments
5:00 pm Adjourn


Panel 1 – Operating Rules

  • EFT/ERA Implementation (January 1, 2014)
  • What is the current status of implementation of EFT/ERA standard and operating rules is there any data?  What does this update tell us and what should we/industry be doing in reaction to it? Are there any known implementation issues with the standard and/or operating rules?  What are some of the early successes with the adoption of these standards/operating rules?
  • Providers:
  • What benefits and obstacles of EFT & ERA are you seeing?
  • What are the current issues with other payment forms such as virtual cards?
  • Development of Operating Rules for all remaining HIPAA transactions (Clams, Enrollment, Premium Payment, Prior Authorization, Claims Attachments)
  • What is the status of development of operating rules for all the remaining HIPAA transactions (Please specify for each transaction)
  • Are there any priority areas for operating rule consideration with respect to specific transactions?

Panel 2 –ICD-10: Achieving a Successful Transition

  • What are the key findings from the latest large-scale industry surveys regarding transition planning and implementation of ICD-10?  What do these key findings tell us and what should we be doing in response to these findings?
  • What is the current status of testing of ICD-10?  What are some of the key initial testing results?
  • What should be the industry focus for the remaining 9 months prior to the compliance date?

Panel 3 – ICD-10 Implementation Beyond Covered Entities

  • What is the current state of adoption of ICD-10 by property/casualty carriers and workers’ compensation carriers and other HIPAA non-covered entities?  What are the perspectives on ICD-10 implementation from TPAs?
  • What are the key issues with non-covered entities not adopting ICD-10 after October 1, 2014?
  • What are the plans for handling claims with and without ICD-10 codes post October 1, 2014?

Panel 4 – Pharmacy Prior Authorization

  • What is the current state of prior authorization transactions within the pharmacy industry?
  • What should the relationship be between the e-Prescribing world (including standards development and maintenance) and the HIPAA world?
  • What is being recommended by the DSMO with respect to the adoption/use of a new standard for pharmacy prior authorization?
  • What are the main benefits for adopting this new standard?  What are the key issues or challenges?  What is the timeline?

Panel 5 – Health Plan ID Planning and Implementation Issues

  • What is the current status of preparation and health plan strategies for adopting the new health plan ID in transactions?
  • What is the current status of preparation and plan strategies for using new health plan ID in transactions?
  • What are the key issues and challenges with the adoption of a health plan ID and Other Entity Identifier (OEID)? How can these issues be addressed?
  • What are the implementation issues/successes with implementing operating rules for TPAs?
  • What is the impact on TPAs and ASOs of HPID and Certification of Compliance?

Should you require reasonable accommodation, please contact the CDC Office of Equal Employment Opportunity on (301) 458-4EEO (4336) as soon as possible.

Times, topics, and speakers are subject to change. For final agenda, please call 301-458-4200 at NCHS or visit the NCVHS Home Page at

February 27, 2014