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NJHA Library & Links
HIPAA Jungle - Selected Web Links & Resources
Section: Designated Standards Maintenance Organizations (DSMOs) & Code Sets
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DSMO Organizations | Miscellaneous
The final HIPAA rules specify the standard "code sets" to be used in all administrative and financial transactions covered by HIPAA. The rule contains vocabularies, terminology and classification systems covering many of the diseases, procedures, medical problems, supplies and services encountered in the healthcare industry. The rule designated six organizations called DSMOs to maintain the standards for these codes and establish criteria for the processes to be used in their maintenance.
For the rules on HIPAA code sets see:
http://www.njha.com/hipaa_section/hipaa.regulations.aspx
DSMO Organizations
Accredited Standards Committee - ANSI (ASC X12). [Web Site]. [Alexandria, VA: Data Interchange Standards Association DISA], 2000. Accessed: July 16, 2001.
http://www.x12.org/
American National Standards Institute (ANSI) chartered the Accredited Standards Committee (ASC) X12 to develop uniform standards for interindustry electronic interchange of business transactions-- electronic data interchange (EDI).
Dental Content Committee of the American Dental Association (DeCC). For further information see: American Dental Association for Accredited Standards [Web Site]. Ann Arbor, MI: Health Level Seven Inc., ©2000. Accessed: July 16, 2001.
http://www.hl7.org/standards/ada.htm Describes the ADA standards and provides contact information.
Health Level Seven (HL7). [Web Site]. Ann Arbor, MI: Health Level Seven Inc., 1997. Accessed: July 16, 2001.
http://www.hl7.org/
Offers a wealth of information such as newsletters, directories, meeting minutes, listservs, press releases, news, extensive resource library, education, data models, standards and special interest groups.
National Council for Prescriptive Drug Programs (NCPDP). [Web Site]. Phoenix, AZ: National Council for Prescription Drug Programs, Inc. Accessed: July 16, 2001.
http://www.ncpdp.org/
An ANSI-accredited Standards Development Organization that develops standards to enable electronic transmissions in pharmacy. Offers news, meetings, standards, industry surveys, online newsletter articles.
National Uniform Billing Committee (NUBC). [Web Site]. Chicago, IL: National Uniform Billing Committee of the American Hospital Association, 1999. Accessed: July 17, 2001.
http://www.nubc.org
A voluntary group coordinated by the American Hospital Association to include participation by all major national provider and payer organizations. It was formed to develop a single billing form and standard data set for nationwide use. One of its major roles is to maintain the integrity of the UB-92 data set and serve as the forum for discussion for other claim-related transactions. Web site offers UB-92 Data Specifications Manual and Mailing List, news features, calendar and links for clinical coding and billing advice.
National Uniform Claim Committee (NUCC). [Web Site]. Chicago, IL: National Uniform Claim Committee of the American Medical Association, ©1997-2001. Accessed: July 17, 2001.
http://www.nucc.org/
NUCC is chaired by the AMA with HCFA as a partner and representation from other key groups. Named in the administrative simplification section of the HIPAA law, NUCC is given authority regarding national standard content and data definitions for non-institutional health care claims in the United States that are intended to complement the work of ASC X12N. The Web site offers a calendar, provider taxonomy, coding sources, links, FAQ for HCFA 1500 claim form and a protocol for its operations.
Miscellaneous
The National Drug Code Directory. [Web Site]. Rockville, MD: U.S. Food and Drug Administration, Center for Drug Evaluation and Research, July 10, 2001. Accessed: August 27, 2001.
http://www.fda.gov/cder/ndc/index.htm
The NDC System was originally established as an essential part of an out-of-hospital drug reimbursement program under Medicare. The NDC serves as a universal product identifier for human drugs. The directory consists of prescription and selected over-the-counter, insulin, domestic and foreign drug products that are in commercial distribution in the United States. The data is updated quarterly. Downloadable files.
Drug Product Data. [Web Site]. Washington, DC: U.S. Department of Health and Human Services, Health Care Financing Administration. Accessed: August 21, 2001.
Contains files for the entire formularly of 56,000 drugs that are available under the Medicaid Drug Rebate program and contains the National Drug Code (NDC) approved by HCFA.
Health Care Procedure Coding System (HCPCS) [Web Site]. Washington, DC: U.S. Health Care Financing Administration. Accessed: August 20, 2001.
http://cms.hhs.gov/medicare/hcpcs/default.asp
Contains all the code sets for HCPCS, corrections and information on accessing the latest HCPCS from a variety of sources.
HCFA Internet Security Policy. [Online]. Baltimore, MD: Office of Information Services, HCFA Security and Standards Group, Division of HCFA Enterprise Standards -Internet, November 24, 1998. Accessed: August 27, 2001.
http://www.cms.hhs.gov/it/security/docs/internet_policy.pdf
This bulletin formalizes the policy and guidelines for the security and appropriate use of the Internet to transmit HCFA Privacy Act-protected and other sensitive HCFA information with individually identifiable data for Medicare and Medicaid. See the security policy FAQs.
Public Use Files (PUFS). [Web Site]. Washington, DC: U.S. Health Care Financing Administration, August 9, 2001. Accessed: August 20, 2001.
http://cms.hhs.gov/providers/pufdownload/default.asp
See ICD-9-CM entry as well as information for HCPCS.
HIPAA-DSMO.ORG. [Web Site]. Rockville, MD: Washington Publishing Company, 2000. Accessed: July 16, 2001.
http://www.hipaa-dsmo.org/
Simple explanation of designated standard maintenance organizations with a FAQ database.
The National Provider Identifier (NPI). [Web Site]. Washington, DC: U.S. Health Care Financing Administration, December 8, 1999. Accessed: August 20, 2001.
http://cms.hhs.gov/providers/enrollment/natlprov.asp
A web site of more than 20 documents discussing the NPI with a page of answers to frequently asked questions (FAQs).
CPT Products and Services. [Web Site]. Chicago, IL: American Medical Association, ©1995-2001.
http://www.ama-assn.org/ama/pub/category/3116.html
AMA's CPT® coding system is designated by the final HIPAA rule as the national standard for reporting healthcare services in electronic transactions. The AMA offers the codes for purchase in several ways as well as useful resources to answer CPT related questions.
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