Dental Caucus
June 5, 2007
Wyndham Orlando Resort / Tangerine B
X12N – Page 1 of 5
Minutes of the X12 Dental Caucus Meeting
Attendees:
Cynthia Anaya, Dept. of Veterans Affairs Tina Olds, MetLife
Timothy L. Brown, NADP Dawn Paine, MetLife
Carla Clark, Tricare Mike Parrish, Delta Dental Virginia
Tom Conway, ADA Dana Patton, Tricare
Tom Drinkard, Mercury Data Exchange Renee Perry, Illinois Medicaid
Ken Erdmann, Delta Dental Michigan Dr. Dave Preble, ADA
Dave Feinberg, Rensis Peter Rausch, Delta Dental Minnesota
Sheila Frank, DDPA, Chair Cheryl Tichonevicz, Highmark
Mark Janney, Delta Dental New Jersey Diane Walker, BCBS Michigan
Theresa Jansen, UCCI Pat Weis, Delta Dental Pennsylvania
Barbara Jones, Metlife Pat Van Dyke, The ODS Companies
1. Sheila Frank opened the meeting at 0705. Introductions were made.
2. The minutes were approved with modifications.
3. Workgroup Updates
o TG2WG1
a. 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.
b. Using the 271 as a response to the 834 will be discussed on Wednesday.
o TG2WG2
a. Starting work on 5050 Guide---anything that needs to be in there probably needs to
be there by this week.
b. Realtime adjudication will be discussed this afternoon between 1 and 4:30
c. Pharmacy will be discussed Wednesday morning – Possible opportunity for dental
people to meet separately if time is needed.
o TG2WG3
a. Using the 835 in Realtime transactions will be discussed
b. Finance will meet with WG3 to discuss Health Savings Accounts and Realtime
Adjudication models
c. 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.
Dental Caucus
June 5, 2007
Wyndham Orlando Resort / Tangerine B
X12N – Page 2 of 5
o TG2WG4
a. using the 834 for enrollment HSA and Retirement plans
o TG2WG5
a. Payer to Payer information flow – to support the AHIP project
o TG2WG9
a. No report
o TG2WG20
a. No report
o TG3
a. Modeling is limited in what it is able to do right now, but hopefully this will change
through the Strategic Planning process.
b. Working with Veterans Health for grant money
c. 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
o American Dental Association (ADA) Tom Conway
a. See Dental Content Committee and SCDI comments
o Standards Committee on Dental Informatics (SCDI) Tom Conway
a. There is an Memorandum of Understanding with HL7 on the Dental Content
b. There is a Technical Report 1059 to propose labeling and migration from 2 dimension
to 3 dimension. Due date is Fall, 2008.
c. Working on a report for a Dental Practice Model for 2020.
o Delta Dental Plans Association Sheila Frank
a. DDPA continues to work on standards issues internally. Sheila distributed DDPA’s
position letter on RASO.
o Dental Content Committee Tim Brown
a. There is a conference call today.
b. NADP now has a voting seat on the committee. Tim Brown has resigned as X12
Liaison to DeCC
c. Tom Drinkard will be proposed by X12 as their new Liaison to DeCC.
o Health Level Seven Sheila Frank
a. 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
Dental Caucus
June 5, 2007
Wyndham Orlando Resort / Tangerine B
X12N – Page 3 of 5
flaws can be fixed without federal regulation. Business drivers to automate manual
processes might be used to justify use, regardless of HIPAA mandates.
o 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
o National Association of Dental Plans (NADP) Tim Brown
a. 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.
6. New Business Tim Brown
o 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.
o 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.
Dental Caucus
June 5, 2007
Wyndham Orlando Resort / Tangerine B
X12N – Page 4 of 5
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.
Dental Caucus
June 5, 2007
Wyndham Orlando Resort / Tangerine B
X12N – Page 5 of 5
Action Item: Sheila Frank and Ken Erdmann.
Due Date: End of June, 2007
o 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.
7. Next Meeting/Sponsor
o Los Angeles trimester meeting. The ADA volunteered to provide the breakfast. NADP
offered to provide food in January.