Events and Latest News
Events and Latest News
HHS Releases Information Bulletin on Publication of Final Rule CMS-0056-F
The Department of Health and Human Services (HHS) has released an Information Bulletin (PDF) informing stakeholders of the Federal Register publication of the final rule CMS-0056-F. This final rule adopts updated versions of the retail pharmacy standards for electronic transactions adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Stakeholders can review a fact sheet (PDF) that provides additional information on this final rule, including relevant background, major provisions, and an implementation timeline.
Introduction to Administrative Simplification (Video)
This video covers how the Centers for Medicare & Medicaid Services (CMS) adopts, promotes, and enforces Administrative Simplification regulations, which standardize how HIPAA covered entities conduct electronic administrative health care transactions. Learn about these regulations, and how they can help to reduce burden and lower costs throughout the health care industry.
Administrative Simplification Fundamentals Fact Sheet (PDF)
This fact sheet provides an overview of Administrative Simplification, its purpose, goals, and how the health care industry benefits from it.
How to Test Electronic Health Care Transactions for HIPAA Compliance (PDF)
The fact sheet (PDF) provides an overview and step-by-step instructions of how to test transactions in ASETT.
ASETT Demonstration Video
This demonstration video walks users through how to register for ASETT, how to use it to file complaints against HIPAA covered entities for noncompliance with Administrative Simplification standards for electronic health care transactions, and how to test their electronic health care transactions, as well as their trading partners' transactions for potential noncompliance.
Administrative Simplification Resources Toolkit (ZIP)
This toolkit (ZIP) features key Administrative Simplification resources, along with a table of contents outlining the information they contain.
Federal Register Notice on Requirements for National Plan and Provider Enumeration System (NPPES) Data Changes CMS-0059-N
This information bulletin (PDF) announces changes to data elements that health care providers are required to submit to the National Plan and Provider Enumeration System (NPPES) to obtain and maintain a National Provider Identifier (NPI).
Statement of Enforcement Discretion for Referral Certification and Authorization Transaction Standard
This guidance letter (PDF) announces an enforcement discretion for HIPAA covered entities that implement FHIR-based Prior Authorization APIs as described in the CMS Interoperability and Prior Authorization final rule (CMS-0057-F).
Statement of Enforcement Discretion for Referral Certification and Authorization Transaction Standard FAQs
These FAQs (PDF) respond to public comments on the National Standards Group’s (NSG) Guidance Letter announcing an enforcement discretion related to the X12 278 Standard.
Overview of the New Administrative Simplification One Pager
This information bulletin (PDF) announces a one pager that explains Administrative Simplification requirements, how CMS enforces them, and where users can find additional guidance.
Guidance on National Provider Identifier (NPI) Enumeration
This guidance letter (PDF) clarifies the prohibition at 45 CFR § 162.412(b) that a health plan may not require a health care provider that has been assigned an NPI to obtain an additional NPI.
HIMSS23: HIPAA Standard Transactions Presentation
HIMSS23: HIPAA Standard Transactions Presentation (PDF)
Slides from the HIPAA Standard Transactions presentation at HIMSS23 on April 18, 2023.
Notice Regarding Publication of Proposed Rule: Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions, Acknowledgment Transactions, and Electronic Signatures, and Operating Rules for Acknowledgment Transactions, and Modification to Referral Certification and Authorization Transaction Standards (CMS 0053-P)
The National Standards Group (NSG), on behalf of the Department of Health and Human Services (HHS), has released a new Information Bulletin on the Notice of Proposed Rulemaking (NPRM) CMS-0053-P that was recently displayed in the Federal Register. The proposed rule, if finalized, would make a regulatory change that would implement requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), enacted on March 30, 2010 (collectively, the ACA).
The public comment period for this rule is extended to 5 p.m. ET on April 21, 2023.
For more information on the proposed rule, read the Information Bulletin (PDF), fact sheet, and press release.
Materials from the February session are available here:
- Listening Session Slides (PDF) (PDF) – presentation slides from the February 2023 national call about the Adoption of Standards for Health Care Attachments Transactions, Acknowledgment Transactions, and Electronic Signatures, and Operating Rules for Acknowledgment Transactions, and Modification to Referral Certification and Authorization Transaction Standards NPRM (CMS 0053-P)
- Listening Session Transcript (PDF) (PDF) – a transcript of the February 2023 listening session about the Adoption of Standards for Health Care Attachments Transactions, Acknowledgment Transactions, and Electronic Signatures, and Operating Rules for Acknowledgment Transactions, and Modification to Referral Certification and Authorization Transaction Standards NPRM (CMS 0053-P)
Materials from the January session are available here:
- Listening Session Slides (PDF) (PDF) – presentation slides from the January 2023 national call about the Adoption of Standards for Health Care Attachments Transactions, Acknowledgment Transactions, and Electronic Signatures, and Operating Rules for Acknowledgment Transactions, and Modification to Referral Certification and Authorization Transaction Standards NPRM (CMS 0053-P)
- Listening Session Transcript (PDF) (PDF) – a transcript of the January 2023 listening session about the Adoption of Standards for Health Care Attachments Transactions, Acknowledgment Transactions, and Electronic Signatures, and Operating Rules for Acknowledgment Transactions, and Modification to Referral Certification and Authorization Transaction Standards NPRM (CMS 0053-P)
Notice Regarding Publication of Proposed Rule: Administrative Simplification: Modification to the National Council for Prescription Drug Programs Retail Pharmacy Standards and Adoption of a New Pharmacy Subrogation Standard (CMS-0056 P)
The Department of Health and Human Services (HHS) announces the Notice of Proposed Rulemaking (NPRM) CMS-0056-P that was recently published in the Federal Register. This NPRM proposes to adopt updated Versions of the retail pharmacy standards for electronic transactions adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
For more information, read the Information Bulletin (PDF) or fact sheet (PDF).
Modification to NCPDP Retail Pharmacy Standards NPRM (CMS-0056 P) Listening Session
Listening Session Slides (PDF) (PDF) – presentation slides from the November 2022 listening session about the Modification to NCPDP Retail Pharmacy Standards NPRM (CMS-0056 P)
Listening Session Transcript (PDF) (PDF) – a transcript of the November 2022 listening session about the Modification to NCPDP Retail Pharmacy Standards NPRM (CMS-0056 P)
Administrative Simplification Basics Fact Sheets
The Centers for Medicare & Medicaid Services (CMS) National Standards Group (NSG) announces the release of a series of fact sheets explaining the basics of HIPAA Administrative Simplification transactions and code sets. The fact sheets are designed to help the health care industry understand the purpose of HIPAA adopted transactions and to explain which standards and operating rules govern each transaction.
Health Care Transactions Basics (PDF) – provides an overview and background for all adopted transactions
Electronic Funds Transfer and Electronic Remittance Advice Transactions (PDF) – describes the EFT and ERA transactions and provides information on the adopted standards and operating rules
EFT and ERA: Payment Remittance Reassociation Basics (PDF) – explains EFT and ERA reassociation and how HIPAA standards and operating rules simplify and streamline the reassociation process
Coordination of Benefits Transactions (PDF) – describes the COB transaction and provides information on the adopted standard
Claim Status Transactions (PDF) – describes the claim status inquiry and response transaction and provides information on the adopted standard and operating rules
Eligibility and Benefits Transactions (PDF) – describes the eligibility and benefits inquiry and response transaction and provides information on the adopted standard and operating rules
Code Sets – describes the purpose of code sets and provides information on Administrative Simplification code sets
D.0 Final Rule
The Department of Health & Human Services (HHS) announces the January 24, 2020, Federal Register publication of the Final Rule (FR) CMS-0055-F, which modifies the requirements for use of the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Implementation Guide, Version D, Release 0, August 2007, by requiring the use of the Quantity Prescribed (460-ET) field to identify partial fills for Schedule II drugs.
For more information, read the full information bulletin on the Go-to-Info page.
Page Last Modified:
12/12/2024 11:34 AM