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Transaction and Code Sets Standards


Transactions are activities involving the transfer of health care information for specific purposes. Under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), if a health care provider engages in one of the identified transactions, they must comply with the standard for that transaction. HIPAA requires every provider who does business electronically to use the same health care transactions, code sets, and identifiers. HIPAA has identified ten standard transactions for Electronic Data Interchange (EDI) for the transmission of health care data. Claims and encounter information, payment and remittance advice, and claims status and inquiry are several of the standard transactions. Code sets are the codes used to identify specific diagnosis and clinical procedures on claims and encounter forms. The HCPCS, CPT-4 and ICD-9 codes with which providers are familiar, are examples of code sets for procedures and diagnose.  

HIPAA Information Series for Providers- A series of ten papers devoted to electronic transactions and code sets.  To view these papers, see the "Related Links Inside CMS" section below.


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Related Links Inside CMS
HIPAA Information Series for Providers

HIPAA - General Information

HCPCS Release and Code Sets
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Page Last Modified: 12/14/2005 12:00:00 AM
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