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18. What level of detail should be included in the X12N implementation guides? Would it be inappropriate for X12N to try to integrate payer-specific communications into the IGs?

The implementation guides developed by X12N and proposed for adoption by HHS as national standards are intended to be at a level of detail sufficient to assure identical implementations by every entity regarding the data content and format of transactions. We must all work together to make sure that the documentation is adequate to meet this purpose, as intended by the Congress. Communications between trading partners about how internal processing of the data may occur must be clearly differentiated from the implementation of the data standards themselves.

On the other hand, companion documents, which could be described as “Payer-Specific Processing Guides,” could be helpful to providers. For example, there may be procedures that are not covered or that are covered only under certain circumstances. It would be useful to a biller to understand this, so that the biller would not prepare a claim for such procedures unless a denial letter was needed to send to a next-to-pay health plan. However, if sent, the actual claim would be the same as any other claim.

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