The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Department of Health and Human Services (HHS) to adopt national standards for the Electronic Data Interchange of certain covered healthcare transactions.
Transactions and Code Sets Modification - Current
On January 16, 2009, HHS issued the Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards Final Rule which modified the original Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice by adopting version 5010 of the ASC X12N transactions, version D.0 of the NCPDP Telecommunication Standard Implementation, version 1.2 of the NCPDP Batch Standard Implementation, and version 3.0 of the NCPDP Medicaid Pharmacy Subrogation standard.
The Final Rule established January 1, 2012 as the implementation deadline for the new versions. Two discretionary enforcement periods were announced: the first period extending from January 1, 2012 through March 31, 2012 and the second period extending from April 1, 2012 through June 30, 2012. The discretionary enforcement periods did not change the compliance date of the regulation – the enforcement delays simply stated that CMS would not enforce compliance.
View the Regulation
Purchase the Standards on the ASC X12 Store
Transaction Standards Modification Version 7030™ - Anticipated
The ASC X12N Insurance Subcommittee is finalizing version 7030 of the both the mandated and voluntary healthcare Technical Reports Type 3 (TR3s). It is anticipated that ASC X12N will recommend that version 7030 of the mandated transaction standards be adopted under HIPAA.
The cycles for review and comment of the TR3s has been established by X12N and will be staggered into several overlapping cycles. See the home page of www.hipaasimplified.com for more information from Change Healthcare about the Public Review and Comment Period for the version 7030™ TR3s.
Timeline for the Comment Period
Online ASC X12 Public Review Forum
Transactions and Code Sets Rule – Original (Superseded)
To carry out the provisions of HIPAA, HHS published the Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice on August 17, 2000. This regulation named version 4010 of the following transactions as a HIPAA standard:
- ASC X12N Health Care Eligibility Benefit Inquiry and Response (270/271)
- ASC X12N Health Care Claim Status Request and Response (276/277)
- ASC X12N Health Care Claims: Professional (837P), Institutional (837I), Dental (837D)
- ASC X12N Health Care Claim Payment/Advice (835)
- ASC X12N Health Care Services Review – Request for Review and Response (278)
- ASC X12N Benefit Enrollment and Maintenance (834)
- ASC X12N Payroll Deducted and Other Group Premium Payment for Insurance Products (820)
- NCPDP Telecommunication Standard Implementation version 5.1
The implementation deadline for this regulation was October 16, 2003.
HHS published the Health Insurance Reform: Modifications to Electronic Data Transaction Standards and Code Sets Final Rule on February 20, 2003 which modified the original Transactions and Code Sets Final Rule by adopting errata versions of the named transactions.
View the Original Regulation
View the Errata Modification