The Health Insurance Portability and Accountability Act (HIPAA) Transactions, Code Sets and Identifiers (TCS&I) Program facilitates the implementation of nationwide standards of HIPAA-compliant electronic administrative health care transactions for the Military Health System (MHS). The current adopted transaction standards are:
- Accredited Standards Committee (ASC) X12 Insurance (X12N), Version 5010
- National Council for Prescription Drug Programs (NCPDP) Telecommunication, Version D.0
- NCPDP Medicaid Subrogation, Version 3.0
Health plans, clearinghouses, and providers are required to submit or receive these adopted electronic transactions for the purposes intended in order to be HIPAA compliant. The adopted transactions used by the MHS are listed in their business process sequence in the Transactions Table. Applicable transactions have been implemented successfully and are currently in use by the MHS.
The original Transactions and Code Sets Final Rule, dated August 2000, adopted American National Standards Institute (ANSI) X12 (Version 4010) and NCPDP Telecommunication Standard Version 5.1 and Batch Standard Version 1.0 transaction standards for eight types of administrative transactions.
In January 2009, the Department of Health and Human Services (HHS) published the Modifications to HIPAA Electronic Transaction Standards Final Rule which adopted updated versions (X12 Version 5010 and NCPDP D.0) of the standards that were adopted in 2000. The 2009 Final Rule also adopted standards to be used for Medicaid Pharmacy Subrogation and billing of retail pharmacy professional services and supplies. The compliance date for use of the updated versions was January 1, 2012.
Within the next five years, the industry is anticipating implementation of the next version of ASC X12N transactions.
In addition to X12 and NCPDP, the HIPAA TCS&I Program has worked with and is currently monitoring several other transaction initiatives, including Electronic Funds Transfer (EFT) and Remittance Advice (RA), Operating Rules for HIPAA Transactions, and Health Claims Attachments.
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Fact Sheet
2/10/2015
The Electronic Funds Transfers (EFT) and Remittance Advice (RA) Transaction Fact Sheet discusses the background of EFT and RA standards adoption, what the standards are, why they are needed in industry, and who is affected by the adoption of these standards.
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Fact Sheet
2/10/2015
The Operating Rules for HIPAA Transactions Fact Sheet discusses the background of the adopted Operating Rules, what they are, how they achieve Administrative Simplification, and what the process is for adopting them.
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Transactions
Fact Sheet
1/20/2015
This fact sheet explains the supplemental health documentation that's needed to support a specific event. The Health Claims Attachments are expected to include a specifically defined set of extracts from the medical record such as an x-ray, lab result, operative report, etc., needed to support the processing of a claim. Health Claims Attachments can be solicited or unsolicited.
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Transactions
Showing results 1 - 3
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