Statutes and Regulations

Key Compliance Dates for Adopted Standards

Statutes

The primary statutes with Administrative Simplification provisions are:

HIPAA also defines privacy and security requirements for protected health information.

  • The Patient Protection and Affordable Care Act (ACA) expanded on the HIPAA provisions. The ACA requires operating rules for transactions, reiterates the standards for electronic funds transfer and claims attachments and the requirement for a unique health plan identifier (HPID)(HPID rescinded in 2019), and requires health plan certification of compliance (rescinded in 2017).  In a separate provision, the ACA directs HHS to conduct outreach to advisory bodies, including the National Committee for Vital and Health Statistics (NCVHS), for input on potential improvements to Administrative Simplification such as:
    • Use of a uniform enrollment for health care providers
    • Expanding scope of standards and operating rules to apply to health-related transactions conducted by organizations like auto insurers
    • Standardized forms for financial audits required by health plans and others
    • More transparent and consistent approach to claims edits by health plans
  • The Administrative Simplification Compliance Act (ASCA) requires all claims be submitted to Medicare electronically except in certain circumstances. To learn more:

A CMS timeline  (PDF)shows the 20-year history of key Administrative Simplification laws and regulations.

Page Last Modified:
11/26/2019 11:42 PM