The Health Insurance Portability and Accountability Act (HIPAA Public Law 104-191) was signed into law in 1996 to provide better portability and accountability. Administrative Simplification standards and resulting rules will have a significant impact on you and health care organizations. As required by Congress in HIPAA, the standards cover health plans, health care clearinghouses, and those health care providers who conduct certain financial and administrative transactions electronically.
Compliance with HIPAA Standards for Electronic Transactions is required by October 16, 2002 or October 16, 2003 if you have filed for an extension. You can consult the US Department of Health and Human Services for more information concerning the EDI and other requirements related to HIPAA.
The Administrative Simplification provisions cover:
- Electronic Transactions
- Unique Identifiers
- Code Sets
Listed below are the mandatory Transaction Standards and codes sets as outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- ASC X12N 837-Health Care Claim: Dental
- ASC X12N 837-Health Care Claim: Professional
- ASC X12N 837-Health Care Claim: Institutional
- ASC X12N 270/271-Health Care Eligibility Benefit Inquiry and Response
- ASC X12N 278-Health Care Services Review / Request for Review and Response
- ASC X12N 276/277 Health Care Claim Status Request and Response
- ASC X12N 834-Benefit Enrollment and Maintenance
- ASC X12N 835-Health Care Claim Payment/Advice
- ASC X12N 820-Payroll Deducted and Other Group Premium Payment for Insurance Products
X12 Standards are required for all HIPAA transactions except for pharmacy claims. In that case, standards developed by the National Council for Prescription Drug Programs (NCPDP) have been adopted.