September 2005

HHS proposes standards for electronic claims

HHS Secretary Mike Leavitt has proposed the adoption of standards for certain attachments to electronic healthcare claims, a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed standards, published in the Federal Register, will apply to electronic transactions by covered entities to request and provide clinical information for certain types of services which are being billed by the provider to the health plan.

Covered entities will be required to use the standards when they are conducting an electronic transaction for the purpose of requesting and providing additional information for one of the six types of services.

These electronic healthcare claims attachment standards have been designed to work in concert with the HIPAA Privacy Rule, the HIPAA Security Rule, and the HIPAA Transactions and Code Set Rule. The proposed standards would use much of the same terminology and definitions.

This proposed rule has a two-month comment period, which ends Nov. 23, 2005. When adopted in a final rule, the attachment standards will affect healthcare providers who transmit health information in electronic form in connection with a transaction covered by HIPAA, health plans, and healthcare clearinghouses, within two years (three years for small health plans) of the effective date of the final rule planned for 2006.

The proposed standards would require covered entities to use certain transactions, messaging standards, and a new code set when they electronically request the additional information, and provide the information in response to the request. Six specific types of attachments are covered by this proposed rule: laboratory results, emergency department services, ambulance services, medications, clinical reports, and nine rehabilitation specialties.

Source: U.S. Department of Health and Human Services, www.hhs.gov

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