overview of candidate standards list

Overview of Candidate Standards List

esMD Initiative, PPA Workgroup

Zeshan A Rajput, MD MS

Standards Development Support Team

A Quick Introduction to the SDS Team

• An S&I Framework communications team specific to standards and their respective organizations

• Standards Development Support (SDS)– Reaching out to SDOs

• Getting access to standards• Helping locate expertise where necessary

– Monitoring for changes to standards– Bringing those changes back to respective SDOs

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Purpose of this Exercise

• The Candidate Standards List serves several functions– Traceability

• Was standard ‘X’ considered in this initiative? • When was it excluded and why? (Answered by Harmonization team during Standards

Analysis)

– Communication• Allows the SDS Team to make sure relevant standards, SDOs, and expertise are

available to the initiative

• Think of this exercise as a brainstorming session– We want high sensitivity, low specificity– In other words, false positives are okay!

• This list is a living document– As the initiative considers new facets, we will update with standards identified

that relate to those

• This document is not meant to infer design decisions or that a particular standard is a better fit than others

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What we are asking for

• Please review the candidate standards list regularly– More often in pre-discovery and discovery– Less often in implementation, pilots, subsequent phases

• Please let us know of any updates• Please let us know how else we can help you

• We need your help in making sure we’ve collectively thought of everything we need to consider

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Use Case 1: CMS Provider Registration –Candidate Standards per Transaction

Content & Structure• X12N 274• UML• XML• Microdata

Cross-Functionality Standards, Profiles & Implementations

Vocab & Code Set• ICD-9-PCS• ICD-10-PCS• LOINC• SNOMED• CPT

Transport & Security

• SOAP

• UDDI• X.509• SAML• TLS

Access Services• LDAP• DNS

• XSPA (Sec)• XUA (Sec)• EUA (Sec)• ATNA (Sec)• CT (Sec)

• XDR (C&S)• HPD (C&S)

• CONNECT (A)• HCSPD (A)• UPD (A)

• Direct (T)• PWP (T)

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Use Case 1PPA Use Case Context Diagram – CMSProvider Registration

CMSProvider / Provider

Organization

Contractors / Intermediaries

HIH

ConnectesM

D G

atew

ay

CMS PD

1. HIH/Provider Sends electronic registration request to CMS

2. CMS sends ESI query to PD to determine

capability of provider / HIH to receive medical

documentation request (eMDR).

3. ESI query response sent to CMS

4. Confirmation of registration sent from CMS

In to CMS

Out from CMS

Provider Information Directories

Key : ESI – Electronic Services Information6

Use Case 1: CMS Provider Registration –Candidate Standards per Transaction

# Transaction Vocab & Code Set

Content & Structure


Access Services

Cross Functional

1Agent/Provider Sends electronic registration request to CMS

ICD-9-PCS, ICD-10-PCS, LOINC, SNOMED, CPT

• X12N 274• XDR• Microdata

• SOAP (T)• SAML (S)

• DNS

• Direct*• CONNECT*

2 CMS sends ESI query to PD to determine capability of provider / HIH to receive medical electronic documentation request (eMDR).

As defined in relevant content standard

• X12N 274• Microdata• HPD

• SOAP (T)• PWP (T)• UDDI (T)• X.509 (S)• XUA (S)• SAML (S)• ATNA (S)

• LDAP• DNS

• Direct*• CONNECT*• UPD*• HCSPD*

3 ESI query response sent to CMS


• X12N 274• Microdata

• SOAP (T) • XSPA (S)• XUA (S)• SAML (S)

• DNS • Direct*• CONNECT*

4 Confirmation of registration status sent from CMS



• SOAP (T)• XSPA (S)• SAML (S)


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Use Case 1PPA Use Case Context Diagram –Commercial Payer Provider Registration

Commercial Payer Provider /

Provider Organization


Agent

Connect

Gat

eway

Payer PD

1. HIH/Provider Sends electronic registration request to Payer

2. Payer sends ESI query to PD to determine

capability of provider / Agent to receive medical

documentation request (eMDR).

3. ESI query response sent to Payer

4. Confirmation of registration status sent from Payer

In to Payer

Out from Payer


Key : ESI – Electronic Services Information8

# Transaction Vocab & Code Set

Content & Structure


Access Services

Cross Functional

1Agent/Provider Sends electronic registration request to Payer


• X12N 274• XDR• Microdata

• SOAP (T)• SAML (S)• ATNA (S)

• DNS• LDAP


2 Payer sends ESI query to PD to determine capability of provider / Agent to receive electronic medical documentation request (eMDR).


• X12N 274• Microdata• HPD


• LDAP• DNS• HCSPD*

• Direct*• CONNECT*• UPD*

3 ESI query response sent to Payer



• SOAP (T) • XSPA (S)• XUA (S)• SAML (S)• ATNA (S)

• DNS• LDAP


4 Confirmation of registration status sent from Payer



• SOAP (T)• XSPA (S)• XUA (S)• SAML (S)

• DNS• LDAP


Use Case 1: Commercial Payer Provider Registration – Candidate Standards per Transaction

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Content & Structure• X12N 274• X12N 277• UML• XML• Microdata• CDA

Cross-Functionality Standards, Profiles & Implementations

Vocab & Code Set• ICD-9-PCS• ICD-10-PCS• LOINC• SNOMED• CPT


• SOAP

• UDDI• X.509• SAML• TLS

Access Services• LDAP• DNS

• XSPA (Sec)• XUA (Sec)• EUA (Sec)• ATNA (Sec)• CT (Sec)

• CONNECT (A)• HCSPD (A)• UPD (A)

• Direct (T)• PWP (T)

Use Case 2: Payer sends eMDR to Provider

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• XDR (C&S)• HPD (C&S) • NHIN CAQH CORE X121

• Phase II CORE 2702

Use Case 2PPA Use Case Context Diagram – CMSSecure MDR transmission from Contractor to Provider

CMSProvider / Provider

Organization



HIH

ConnectesM

D G

atew

ay

In to ContractorOut from Contractor

5. Electronic medical documentation request (MDR) sent securely to Provider or HIH as needed *

1. Sends request for provider registration status

4. Receives updated ESI

Information

2. Receives validation of registration status

3. Sends request to retrie

ve

updated ESI informationOut to Provider

CMS PD

Key : ESI – Electronic Services Information* Electronic MDR is sent only when CMS identifies the need for documentation. 11

Use Case 2: CMS Contractor Sends eMDR to Provider – Candidate Standards per Transaction

# Transaction Vocab & Code Set Content & Structure Transport & Security Access Services Cross Functional

1Sends request for Provider registration status


• X12N 274• Microdata• NHIN CAQH CORE X12• Phase II CORE 270

• SOAP (T)• XSPA (S)• XUA (S)• SAML (S)

• DNS • Direct* • CONNECT*

2 Receives validation of registration request



• SOAP (T)• X.509 (S)• XUA (S)• SAML (S)• ATNA (S)


3 Sends request to retrieve updated ESI information


• X12N 274• Microdata• HPD • NHIN CAQH CORE X12• Phase II CORE 270


• DNS• HCSPD*


4 Receives updated ESI information




• DNS• HCSPD*


5 An eMDR is sent securely to Provider / HIH as needed





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Use Case 2PPA Use Case Context Diagram – Secure eMDR transmission from Commercial Payer to Provider

Commercial Payer Provider /

Provider Organization



Agent

Connect

Gat

eway

In to ContractorOut from Contractor

5. Electronic medical documentation request (eMDR) sent securely to Provider or Agent as needed *

1. Sends request for provider registration status


Information

2. Receives validation of registration status

3. Sends request to retrie

ve


Payer PD

Key : ESI – Electronic Services Information* eMDR is sent only when Payer identifies the need for documentation.

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Use Case 2PPA Use Case Context Diagram – Secure eMDR transmission from Commercial Payer to Provider

Commercial Payer

Provider / Provider

Organization



Agent

Connect

Gat

eway

3. Electronic medical documentation request (eMDR) sent securely to Provider or Agent as needed *


Information

1. Sends request to retrieve


Payer PD

Key : ESI – Electronic Services Information* eMDR is sent only when CMS identifies the need for documentation.

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overview of candidate standards list

Documents

direct t pwp t

sure relevant standards

capability of provider

esi query response

relevant content standard

cpt x12n

consider3use case

particular standard