Events and Latest News

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.