HIPAA General Information

The Act

In August 1996, President Clinton signed into the law the Health Insurance Portability and Accountability Act (HIPAA). The Act included provisions for health insurance portability, fraud and abuse control, tax related provisions, group health plan requirements, revenue offset provisions, and administrative simplification requirements.

Administrative Simplification

About 25% of each health care dollar is spent on administrative overhead, which includes such activities as enrolling beneficiaries in a health plan, paying health insurance premiums, and filing claims. One part of this Act, referred to as Administrative Simplification (AS), is aimed at reducing administrative costs and burdens in the health care industry. It requires the Department of Health and Human Services (HHS) to adopt national uniform standards for the electronic transmission of certain health information. The health care industry estimates that full implementation of the provisions of AS could save as much as $9 billion per year on administrative overhead, while improving efficiency and quality of health care services. For more information on Administrative Simplification, go to the Centers for Medicare and Medicaid Services (CMS) HIPAA - General Information website.

HIPAA Notices of Proposed Rule Making and Final Rules

Electronic Transactions and Operating Rules
Code Sets
Identifiers
Claims Attachments
HIPAA Enforcement

Implementation Guides

For each standard electronic transaction there is an implementation guide which is the specification for implementing the standard.

Implementation Guides for ASC X12N standards.
Implementation Guides for NCPDP standards.

Maintenance of Transaction Standards

With the publication of the final Electronic Transaction and Code Sets rule, the Secretary of HHS announced Designated Standard Maintenance Organizations (DSMOs) to maintain the standards adopted by the Secretary.

Announcement of Designated Standard Maintenance Organizations.

The DSMOs have agreed to receive and process requests for adopting a new standard or modifying an adopted standard according to the criteria established in the final rule.