Purpose
The purpose of this document is to highlight some of the terms used in the development
and use of the ANSI ASC X12 standards. All definitions in italics are taken from the
WEDI HIPAAA Glossary.
http://www.wedi.org/public/articles/HIPAA_GLOSSARY.pdf
This glossary is intended to provide a user-friendly way to start to understand the
terminology used to develop and maintain ANSI ASC X12 standards used for public
health implementations.
Terms of Note
Accredited Standards Committee (ASC)
An organization that has been accredited by ANSI for the development of American
National Standards.
American National Standards Institute (ANSI)
An organization that accredits various standard-setting committees, and monitors their
compliance with the open rule-making process that they must follow to qualify for ANSI
accreditation.
Data Maintenance (DM)
The name given to change requests to X12 Standards.
Data-Related Concepts
Clinical or Medical Code Sets
Medical conditions and the procedures, services, equipment, and supplies used to deal
with them.
Non-clinical or Administrative Code Sets
Entities and events that facilitate administrative processes.
External Code Set
Date element code lists that are fully specified and maintained by external organizations.
Maintenance of these code lists is the sole responsibility of the external organization.
Internal Code Set
Data element code lists that are fully specified and maintained within the X12 standards.
Note changes to Internal Codes Sets must be approved as part of the normal standards
development process.
Composite Data Elements
Groups of closely related data elements that can repeat as a group. (i.e. procedure code
and associated procedure date are defined in a composite data element)
Simple Data Elements
The smallest unit of named information in the ANSI ASC X12 standards
Segments
Groups of related data elements that typically occur together. (i.e. street address, city,
state, and zip code)
Loops
The collection of segments that can repeat.
Transaction Set
A collection of loops and segments that support specific business processes.
Designated Standards Maintenance Organizations (DSMO)
The organizations (X12, HL7, NCPDP, NUBC, NUCC, ADA) named in the HIPAA
legislation to administer the change process to the named HIPAA transactions. Note:
changes to any loops or segments in the standard that are used in HIPAA implementation
guides must be routed through the DSMO process.
DSMO Organizations
DeCC
Dental Content Committee chaired and hosted by the American Dental
Association. This is a data content organization.
NUBC
National Uniform Billing Committee chaired and hosted by the American
Hospital Association. This is a data content organization whose primary
responsible for UB institutional claim form and data specifications. The current
version is the UB-04, which replaced the UB-92.
NUCC
National Uniform Claim Committee chaired and hosted by the American Medical
Association. This is a data content organization whose primary responsible for
HCFA-1500 professional claim form and data specifications.
Health Level 7 (HL7)
An ANSI-accredited group that defines standards for the cross-platform exchange
of information within a health organization. This is a standards development
organization (SDO).
National Council for Prescription Drug Programs (NCPDP)
An ANSI-accredited group that maintains a number of standard forms for use by
the retail pharmacy industry, some of which are included in the HIPAA mandates.
This is a standards development organization (SDO).
X12
An ANSI-Accredited group that defines EDI standards for many American
Industries, including health care insurance. This is a standards development
organization (SDO).
Implementation Guide
A document explaining the proper use of a standard for a specific business purpose. An
implementation guide is always a subset of the set of loops, segments, and data elements
in any defined standard.
Required Usage
Segments and Data Elements that must be reported in an implementation of a certain
standard.
Situational Usage
Segments and Data Elements that may be reported in an implementation of a certain
standard depending on the situational statement that is written in the guide.
X12 Versions
A number indicating when the standard was updated with approved changes. The 4010
Version of the standard was for approved updates as of October 1997. The 4050 version
of the standard was for approved updates as of October 2001. The 5010 version of the
standard was for approved updates as of October 2003. The 6020 version of the standard
was for approved updates as of October 2009.
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