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Administrative Simplification Basics Fact Sheets

The Centers for Medicare & Medicaid Services (CMS) National Standards Group (NSG) announces the release of a series of fact sheets explaining the basics of HIPAA Administrative Simplification transactions and code sets. The fact sheets are designed to help the health care industry understand the purpose of HIPAA adopted transactions and to explain which standards and operating rules govern each transaction.

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Health Care Transactions Basics (PDF) – provides an overview and background for all adopted transactions
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Electronic Funds Transfer and Electronic Remittance Advice Transactions (PDF) – describes the EFT and ERA transactions and provides information on the adopted standards and operating rules
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Coordination of Benefits Transactions (PDF) – describes the COB transaction and provides information on the adopted standard
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Claim Status Transactions (PDF) – describes the claim status inquiry and response transaction and provides information on the adopted standard and operating rules
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Eligibility and Benefits Transactions (PDF) - describes the eligibility and benefits inquiry and response transaction and provides information on the adopted standard and operating rules
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Code Sets (PDF) – describes the purpose of code sets and provides information on Administrative Simplification code sets

D.0 Final Rule

The Department of Health & Human Services (HHS) announces the January 24, 2020, Federal Register publication of the Final Rule (FR) CMS-0055-F, which modifies the requirements for use of the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Implementation Guide, Version D, Release 0, August 2007, by requiring the use of the Quantity Prescribed (460-ET) field to identify partial fills for Schedule II drugs.

For more information, read the full information bulletin on the Go-to-Info page.

Page Last Modified:
07/29/2020 10:11 AM