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Standards for Electronic Transactions-New Versions, New Standard and New Code Set On August 22, 2008, HHS published two proposed rules to adopt updated HIPAA standards; these rules are available at the Federal Register. In one proposal, HHS adopts X12 Version 5010 and NCPDP Version D.0 for the HIPAA transactions. In this rule, HHS also proposes to adopt a new standard for Medicaid subrogation, for pharmacy claims, known as NCPDP Version 3.0. In a separate proposed rule, HHS proposes to adopt the ICD-10 code set to replace the ICD-9 code sets in HIPAA transactions. Version 5010 accommodates the ICD-10 code sets, and has an earlier compliance date than ICD-10 in order to ensure adequate testing time for the industry. These two rules apply to HIPAA covered entities, including health plans, health care clearinghouses, and certain health care providers. Important message regarding comments to the proposed rules: comments submitted through the CMS website "feedback" mechanism do NOT constitute a formal response to these proposed rules. For consideration, you MUST submit comments according to the directions and timelines for submitting comments, included in the "Addresses" section of each proposed rules. The proposed rules give an outdated website address for the ASC X12 Version 5010 TR3 Technical Reports/5010 Implementation Guides. These are now available from ASC X12 directly. The Version 4010/4010A guides are still available on the Washington Publishing Company site. A link to the ASC X12 website is provided in the Related Links Outside CMS section below. To view both proposed rules, see the links in the Related Links Outside CMS section below. To view Fact Sheets information for both proposed rules, see the link in the Related Links Inside CMS. Version 5010 Regulatory Impact Analysis-Supplement CMS is pleased to provide this supplemental document to the proposed rule on Modifications to the HIPAA Standards. This document summarizes the assumptions described in the impact analysis, and offers additional narrative for the calculations in each category. It only covers the cost benefit analysis for Version 5010, and does not address NCPDP Version D.0 or 3.0. This document is not part of the proposed rule itself, and comments received about this document will not be considered in the comment review process. To submit comments specific to the regulation, you must use the process outlined in the proposed rule. To view, see the link in the Downloads section below.
Modifications Rule to Electronic Data Transaction Standards and Code Sets The Final Rule adopting changes to the HIPAA Electronic Transactions and Code Set Standards was published in the Federal Register on February 20, 2003. This final rule modifies a number of the electronic transactions and code sets adopted as national standards under HIPAA, and eliminates the National Drug Code (NCD) code set as the standard for all providers except retail pharmacies. To view, see the link in the Downloads section below. Standards For Electronic Transactions-Final Rule The final rule adopting standards for eight electronic transactions and for code sets to be used in those transactions was published in the Federal Register on August 17, 2000. The use of these standard transactions and code sets will improve the Medicare and Medicaid programs, other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. To view, see the link in the Downloads section below. Standards For Electronic Transactions-Proposed Rule The proposed rule for HIPAA Electronic Transactions was published in the Federal Register on May 7, 1998. This rule proposed standards for eight electronic transactions and for code sets to be used in those transactions. It also proposed requirements concerning the use of these standards by health plans, health care clearinghouses, and health care providers. To view, see the link in the Downloads section below.
Standards For Electronic Transactions-Corrections Technical corrections to the final rule were published in the Federal Register on November 24, 2000. To view, see the link in the Downloads section below.
Designated Standards Maintenance Organizations (DSMO) The Designated Standards Maintenance Organizations were announced in the Federal Register on August 17, 2000. To view, see the link in the Downloads section below.
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