HIPAA Administrative Simplification Rules

The HIPAA Administrative Simplification Rules establish national standards for electronic transactions and code sets to maintain the privacy and security of Protected Health Information (PHI). These standards are often referred to as electronic data interchange or EDI standards. The regulations, detailed in 45 CFR 160, 45 CFR 162, and 45 CFR 164, aim to make healthcare systems more efficient and effective by streamlining paperwork associated with billing, verifying patient eligibility, and payment transactions. HIPAA regulations includes four standards covering transactions, identifiers, code sets, and operating rules. HIPAA covered entities (which include healthcare providers, health plans, healthcare clearinghouses) and HIPAA business associates must adopt these standards for transactions that involve the electronic exchange of healthcare data. Such transactions may include claims and checking claim status. The Administrative Simplification provisions of the Affordable Care Act of 2010 (ACA), build on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements with several new, expanded, or revised provisions, including requirements for: Operating rules for each of the HIPAA transactions Enumeration of a unique, standard Health Plan Identifier (HPID) New standards for electronic funds transfer and electronic health care claims attachments Health plans certification of compliance with the standards and operating rules Penalties for health plans that fail to comply or to certify their compliance with applicable standards and operating rules. More information: [https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html](https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html)