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The underlying version 005010 and 008060 EDI Standard and associated implementation guides are not being modified or republished based on this workaround guidance.
This workaround guidance is provided as a courtesy so that implementers transmitting URLs based on federal guidance or a health plan's direction can implement a consistent workaround until a future version supports transmitting the information. When this workaround guidance is published, expectations for this interchange include the following:
Providers and health plans will exchange URLs
URLs will be transmitted in their entirety in one REF segment; therefore, there will be no splitting or reassociation instructions.
URLs submitted in a claim sent by a provider to a health plan are stored in the health plan's system but are not re-transmitted in the related 835.
Health plans return different URLs to the provider in the related 835.
A URL can be sent at the claim or service line level or both.
The URLs are case-sensitive.
The URLs are created by a trusted system and received by a trusted system, meaning the probability of malicious content is very low. In addition, the URLs are not “clickable”; they are simply transmitted as a string of characters. Storing this string of characters presents low to no risk for the receiver.
The workaround guidance is viewable in context in the GLASS version of the implementation guide as supplemental information included as a courtesy to implementers who are transmitting a URL to support interoperability or the patient's right of access.
This is consistent with other courtesy material, such as the mandated operating rule links and FHIR mapping information.
A few of the workaround guidance instructions do not align with the underlying EDI Standard or the impacted implementation guide. These misalignments are necessary to meet the business requirements of the enhancement, including the following:
The maximum number of repetitions defined in the EDI Standard or the implementation.
The maximum length in the EDI Standard.
The functionality supported via this workaround guidance is expected to be considered for inclusion in a future version of the X12 EDI Standard and associated implementation guides via X12's maintenance request (MR) process. The revisions to the EDI Standard and associated implementation guides identified in the MR process are likely to differ from the solution laid out in this guidance. The solution developed via MR will be fully compliant with the EDI Standard and all impacted implementation guides.