Dental Caucus June 5, 2007 Wyndham Orlando Resort / Tangerine b x12N – Page of 5

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Dental Caucus

June 5, 2007

Wyndham Orlando Resort / Tangerine B

X12N – Page of 5


Minutes of the X12 Dental Caucus Meeting

Cynthia Anaya, Dept. of Veterans Affairs

Timothy L. Brown, NADP

Carla Clark, Tricare

Tom Conway, ADA

Tom Drinkard, Mercury Data Exchange

Ken Erdmann, Delta Dental Michigan

Dave Feinberg, Rensis

Sheila Frank, DDPA, Chair

Mark Janney, Delta Dental New Jersey

Theresa Jansen, UCCI

Barbara Jones, Metlife
Tina Olds, MetLife

Dawn Paine, MetLife

Mike Parrish, Delta Dental Virginia

Dana Patton, Tricare

Renee Perry, Illinois Medicaid

Dr. Dave Preble, ADA

Peter Rausch, Delta Dental Minnesota

Cheryl Tichonevicz, Highmark

Diane Walker, BCBS Michigan

Pat Weis, Delta Dental Pennsylvania

Pat Van Dyke, The ODS Companies

1. Sheila Frank opened the meeting at 0705. Introductions were made.

2. The minutes were approved with modifications.

  1. Workgroup Updates

    • TG2WG1

  1. At 1500 today, Required Alternate Search Options (RASO) will be discussed. There has apparently been a possible resolution arrived at between CMS and the Provider Caucus.

  2. Using the 271 as a response to the 834 will be discussed on Wednesday.

    • TG2WG2

  1. Starting work on 5050 Guide---anything that needs to be in there probably needs to be there by this week.

  2. Realtime adjudication will be discussed this afternoon between 1 and 4:30

  3. Pharmacy will be discussed Wednesday morning – Possible opportunity for dental people to meet separately if time is needed.

    • TG2WG3

  1. Using the 835 in Realtime transactions will be discussed

  2. Finance will meet with WG3 to discuss Health Savings Accounts and Realtime Adjudication models

  3. The Remark codes request submitted by Delta Dental and supported by NDEDIC and Medicaid were recommended to be accepted by the Remarks Code Committee as temporary codes provided they are used only with CARC 119. It was recommended to re-evaluate the continuance of these codes at 18 months to see if the 835 has really gained acceptance through this use.

  • TG2WG4

  1. using the 834 for enrollment HSA and Retirement plans

  • TG2WG5

  1. Payer to Payer information flow – to support the AHIP project

  • TG2WG9

  1. No report

  • TG2WG20

  1. No report

  • TG3

  1. Modeling is limited in what it is able to do right now, but hopefully this will change through the Strategic Planning process.

  2. Working with Veterans Health for grant money

  3. TG3WG3 is developing processes for handling comments from the federal government when the NPRM for 5010 version adoption is published.

4. Actions of Industry Organizations

a. See Dental Content Committee and SCDI comments

  • Standards Committee on Dental Informatics (SCDI) Tom Conway

  1. There is an Memorandum of Understanding with HL7 on the Dental Content

  2. There is a Technical Report 1059 to propose labeling and migration from 2 dimension to 3 dimension. Due date is Fall, 2008.

  3. Working on a report for a Dental Practice Model for 2020.

  • Delta Dental Plans Association Sheila Frank

a. DDPA continues to work on standards issues internally. Sheila distributed DDPA’s position letter on RASO.

  • Dental Content Committee Tim Brown

  1. There is a conference call today.

  2. NADP now has a voting seat on the committee. Tim Brown has resigned as X12 Liaison to DeCC

  3. Tom Drinkard will be proposed by X12 as their new Liaison to DeCC.

  1. Periodontal Attachment is on schedule to go out to ballot this summer.

Sheila encouraged all plans to review the work and make comment. She also encouraged plans to pilot these standards before they are recommended for HIPAA adoption so that flaws can be fixed without federal regulation. Business drivers to automate manual processes might be used to justify use, regardless of HIPAA mandates.

    • National Dental EDI Council Theresa Jansen

a. The NDEDIC Conference was a great success. Realtime claim was high on the agenda. Dental feels they have a number of plans with various implementations of RealTime and could be successful with this earlier than other parts of the industry

b. 835 Cookbook for implementation has been suggested as a development project

  • National Association of Dental Plans (NADP) Tim Brown

  1. This report was given as part of the Dental Content Committee report.

5. X12N’s HIPAA Transactions: Putting in Your Oar Dave Feinberg

Dave presented a wonderful, new training program on moving through the workgroup processes, comment handling and roadmap of approval through the X12 maze.

    1. New Business Tim Brown

      • RASO in 5010 version of 270/271: It is possible that CMS and the Provider Caucus cochairs have arrived at a compromise position. This will probably be presented at 1500 at TG2WG1 today. Sheila distributed DDPA’s position letter on RASO.

      • Tooth Numbering Systems in EDI transactions and Periodontal Attachment

HL7 is an international body and would like to see the both the JO and JP indicators.

Tim Brown presented the proposed wording supporting both the International and US Realm specific code qualifiers in the periodontal attachment. That proposed wording is included in italics below:

XXX: Universal/National Tooth Numbering System - (ANSI ASC X12 Code Set Qualifier "JP")
The Universal/National System numbering system is a dental notation system for associating information to a specific tooth, and is commonly used in the United States. The Universal/National System is identified as code set “JP” in references found in the ADA Dental Claim form and on HIPAA standard electronic dental claim transactions. The Universal/Tooth Numbering System is required on all HIPAA compliant transactions and for use on the ADA Claim Form.
The uppercase letters A through T are used for primary teeth and the numbers 1 - 32 are used for permanent teeth. The tooth designated "1" is the right maxillary third molar and the count continues along the upper teeth to the left side. Then the count begins at the left mandibular third

molar, designated number 17, and continues along the bottom teeth to the right side. Each tooth has a unique number or letter, allowing for use within electronic data interchange (EDI) protocols.
The Universal/National System is published by the American Dental Association (ADA) in the Current Dental Terminology and is available from the ADA at:
Salable Materials

American Dental Association

211 East Chicago Avenue

Chicago, IL 60611-2678

XXX: International Standards Organization System - ANSI/ADA/ISO Specification No. 3950 (ANSI ASC X12 Code Set Qualifier "JO")

The FDI World Dental Federation notation, or International Standards Organization System, is widely used by dentists internationally to associate information to a specific tooth. Developed by the Fédération Dentaire Internationale (FDI), it is also known as ISO-3950 notation. The International Standards Organization System is identified as code set “JO” in references found in the ADA Dental Claim form.   The International Standards Organization System cannot be used with HIPAA compliant transactions.
The FDI system uses a two-digit numbering system in which the first number represents a tooth's quadrant and the second number represents the number of the tooth from the midline of the face. For permanent teeth, the upper right teeth begin with the number, "1". The upper left teeth begin with the number, "2". The lower left teeth begin with the number, "3". The lower right teeth begin with the number, "4". For primary teeth, the sequence of numbers goes 5, 6, 7, and 8 for the teeth in the upper left, upper right, lower right, and lower left respectively.
The International Standards Organization System was developed by the Fédération Dentaire Internationale (FDI), or FDI Dental Federation and is available at:
FDI Dental Federation

13 Chemin du Levant

L'Avant Centre

F-01210 Fereney-Voltaire, France
The group felt if this wording was also brought forward into the 837Guide then adding both the JO and JP code qualifiers would be acceptable. Also, as the Periodontal attachment is desired to be an international standard, it cannot be so without support of the international tooth numbering system and codes.
The DDPA has been the only group opposed to having both code qualifiers.

DDPA agreed to take the suggested wording back to its members and develop a recommendation with this or modified wording that would not affect US processing, and see if acceptance can be gained. This needs to be done by the beginning of July in order for the Periodontal ballot to go forward.

Action Item: Sheila Frank and Ken Erdmann.

Due Date: End of June, 2007

  • Proposal to add the tooth number to the 837 Professional Claim guide. This could potentially allow an oral surgeon to submit a single claim rather than both a dental and a professional claim would be advantageous. This would be a DSMO request.

HCPCS Codes: Tom Conway, on behalf of the ADA, has recommended these be omitted from the dental guide as they cannot be used.

Modifiers: Discussion to remove the reference to HCPCS codes but not modifiers. Modifiers may be used by dentistry in the future.
Diagnosis Codes: Use of the HI segment currently limits use of diagnosis codes to situations affecting the adjudication of the claim or relate to oral/maxillofacial surgery anesthesia. Recommended the Syntax note be changed to remove the limitation of anesthesia so diagnosis codes could be used to support any service needed.
Tom Conway will head up an effort to create policies supporting diabetes and extra services based on diagnoses. This will be an item for the next Dental Caucus in September.
Tom Drinkard will talk to Architecture about changing the semantic note on the DM1 segment.

    1. Next Meeting/Sponsor

  • Los Angeles trimester meeting. The ADA volunteered to provide the breakfast. NADP offered to provide food in January.

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