Industry invited to join and participate in the HL7 Da Vinci Project’s newest use case conference calls
Retrieving a duplicate of remittance advice that was previously issued by a payer is a headache-inducing manual process that can involve the use of web portals, phone calls, faxes and emails.
But implementing an HL7 Fast Healthcare Interoperability Resources (FHIR®) Application Programming Interface (API) could change all that.
The HL7 Da Vinci Project has launched a Postable Remittance Advice Use Case with the goal of publishing an implementation guide (IG) for such an API next year. The API will support the request for a duplicate copy of previously issued remittance advice – paper or electronic – in real time to allow efficient, timely and accurate posting of payments.
Remittance advice is a document that healthcare providers receive from insurance companies after submitting a claim. It provides information on the payment status of the claim, including the amount paid, the patient's responsibility and the reason for any denials or adjustments. The purpose of the remittance advice is to inform the healthcare provider of the remittance details and to allow them to reconcile their accounts and ensure that the payment is accurate.
Eliminating a Manual Process
Right now, payers can send remittance advice on paper or they can transmit it electronically using the ASC X12 835 standard. There are times when remittance advice is missing and a duplicate copy is needed, either by the billing provider or another entity. But requesting and receiving a copy is currently a cumbersome, manual process that can require many steps.
“By implementing FHIR-based postable remittance advice, provider software will include workflow functionality to request from a payer a duplicate, postable remittance advice in workflow and ingest the payer’s response,” says Alix Goss, Da Vinci Project Management Office and Senior Consultant at Point-of-Care Partners. “Correspondingly, payers will be capable of automating the processes of receiving and responding to the requests. And clearinghouses will also support capabilities on behalf of their provider and payer customers.”
The automation of the process will be a significant time saver, eliminating the need to chase down missing remittance advice manually, adds Naomi Miao, manager, Business Operations at the software company athenahealth.
“To spread awareness and increase adoption of APIs to reduce manual workflows and enable automation, athenahealth decided to champion the development of a FHIR standard,” she says.
Many Benefits
Miao, who is serving as project co-lead, says the Postable Remittance Advice FHIR API would help cut costs and reduce the risk of human error caused by manual interaction. Benefits to providers and payers would include:
The use case and related FHIR-based implementation guide will greatly simplify the process of getting a copy of an already issued remittance advice in its original format, Miao explains. If the remittance advice was previously issued electronically using the 835 format, the requester would get a copy of that 835 in its original format via the FHIR API. If the remittance advice was previously issued via paper, then the requester would get a PDF copy of that remittance advice in its original format via the API. The payer/clearinghouse also could send both 835 and PDF formats if desired.
The Postable Remittance Advice FHIR API is not intended to replace or modify the current X12 835 process. The API would neither corrupt nor impact the initial 835 transaction’s compliance with the current standard, Miao points out. The FHIR API would be used to search for missing remittance advice using payment or claim information, and then download a copy of the 835 or PDF remittance advice via the API.
“The new API will enable providers to more easily obtain a duplicate version of previously issued electronic or paper remittance advice to reduce their overall burden in reconciling their accounts receivable,” Goss explains.
Get Involved
A diverse group of participants, including Da Vinci members, recently began work on the new use case, meeting each Tuesday from 1 – 2 p.m. ET to help define how to apply FHIR, Goss says. Anyone from industry can join and participate in the use case conference calls.
“Those interested can initially participate in the requirements gathering, then decide their next level of engagement, including implementation guide testing and balloting, with all steps leading to the publication of the implementation guide specification,” she explains.
The timeline calls for starting with defining requirements, then conducting a FHIR gap analysis, working on the IG development and developing a test case and a reference implementation before conducting tests at the September Connectathon event. The implementation guide ballot – soliciting comments on refining the standard – is slated to start in January 2025, followed by ballot reconciliation. Publication is tentatively planned for May 2025.
More information is available at: https://confluence.hl7.org/pages/viewpage.action?pageId=230557166