March 5, 2004

The Honorable Tommy G. Thompson
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201

Dear Secretary Thompson:

As part of its responsibilities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the National Committee on Vital and Health Statistics (NCVHS) is responsible for studying, selecting and recommending standards for electronic health claims attachments. To fulfill these responsibilities, NCVHS’ Subcommittee on Standards and Security recently held hearings on standards for electronic health claims attachments on December 10, 2003, and March 3, 2004.

The Subcommittee heard testimony from providers, health plans, vendors, associations, and standards development organizations about the need for both basic and advanced functionality in a claims attachment standard.  For example, such a standard should be flexible so that providers with minimal infrastructure can electronically transfer claims attachment information to health plans and clearinghouses.  At the same time, the standard should possess the flexibility to permit users with more sophisticated infrastructures to fully leverage their investment in information technology. Health Level Seven (HL7) and Accredited Standards Committee X12N (ASC X12N) have been working to develop a HIPAA claims attachment standard that can meet these requirements.

The Subcommittee heard the need for demonstration projects and pilot studies to document the benefits, costs, work flow requirements, implementation challenges, privacy concerns, and best practices associated with the claims attachment standard. Testifiers also emphasized the need to provide an opportunity for the industry to comment on the results of the pilots and demonstration projects prior to promulgation of the final rule.

NCVHS urges the Department to encourage and support several different claims attachment demonstration projects and pilots that would include a broad representation of affected stakeholders. NCVHS recommends that these demonstration projects and pilots occur expeditiously, so that their results and findings will feed into the development of the claims attachment rule. NCVHS understands that a Notice of Proposed Rule Making (NPRM) concerning electronic claims attachments currently is under development.  We urge the Department to issue this NPRM as soon as possible to provide the industry with initial guidance and direction.  This in turn will help motivate the industry to invest in pilots and demonstration projects. In addition, we recommend that the Department provide for public feedback on the results of the demonstrations and pilots before a final rule is promulgated.

NCVHS wishes to thank you for the opportunity to offer these recommendations.



John R. Lumpkin, M.D., M.P.H.
Chairman, National Committee on Vital and Health Statistics

Cc: HHS Data Council Co-Chairs