HIPAA- Standards for Electronic Transactions
Asprepared by Dunlap & McDowell for 2/28/03 Pragmatics of HIPAA Training
Hereis a link to the FederalRegister: February 20, 2003 (Volume 68, Number 34)] [Rules and Regulations][Page 8381-8399] which gives the current version version of the final rule in text form.
Hereis a link to the same finaltransactions rule in .pdf (Adobe Acrobat) format
Mental Health Professionals:
Under HIPAA Transaction standards mental health professionalswill be required to use HIPAA standard diagnosis and procedure codes, which are ICD rather than DSM.
All electronic transactions regulated by HIPAA must be in theAmerican National Standard’s Institute’s Accredited Standards Committeeformat.
Information about those requirements and their implementationcan be obtained from Washington Publishing Company, PMB 161, 5284 Randolph Road,Rockville, MD, 20852-2116 and on line at http://www.wpc-edi.com
Standard Transactions and Code Sets.
Health plans must be capable of accepting all the requiredstandard transaction submissions by October 16, 200 3.
Note: this date represents a 12-month delay.Coveredentities who wanted additional time were to have submitted an extension request to theDepartment of Health and Human Services by October 16, 2002. Only about 20% of the expected number filed.
Only about 20% of the expected number filed.
Ifyou are worrying because you didn't file note the passage on p. 8384Federal Register / Vol. 68, No. 34 / Thursday, February 20, 2003 / Rules andRegulations which says: ... we recognize that the modificationsadopted as a result of CMS–0003–P and CMS–0005–P are necessary to permitthe transactions covered by these proposed rules to be conducted in standardform, and that such transactions could not feasibly be required before thecompliance date for the modifications in this final rule, October 16, 2003. Wewill not invoke our authority to penalize noncompliance with standards that ourown delay in issuing this final rule has made infeasible.
A provider who submits claims electronically, and/ormakes eligibility, benefit, claims status, and claims inquiries electronically,must transmit these transactions to the health plan in the American NationalStandards Institute Accredited Standards Committee standard (ANSI X12N) format.Each standard has a prescribed format and content for electronic transmission.
Pleasesee the text or .pdf versions of the rule, linked above, for the specifictransactions requirements.
Health plans and healthcare clearinghouses have to be able toaccept all ASC X12N standards formats and content. Providers and professionalshave options.
Professionals billing electronically may rely on aclearinghouse to convert claims to standard format, and to add required datacontent.
A clearinghouse would re-format the transactions and thensubmit to the respective health plan. Providers and professionals may choose tosend standard content to health plans through the Internet (if the health planis set up for this); this is called direct data entry. Finally, providers andprofessionals may be able to adopt the standard format themselves and submit thestandard content and format to the clearinghouse or health plan directly.