Statutes and Regulations
Statutes
The primary statutes that introduced Administrative Simplification provisions are the:
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- The Patient Protection and Affordable Care Act (ACA)
- The Administrative Simplification Compliance Act (ASCA)
HIPAA
- The Health Insurance Portability and Accountability Act of 1996, or HIPAA, enacted to improve the efficiency and effectiveness of the nation’s health care system, includes Administrative Simplification provisions to establish national standards for:
ACA
The Patient Protection and Affordable Care Act, or ACA expanded on the HIPAA provisions, including by requiring operating rules for transactions.
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
ASCA
- The Administrative Simplification Compliance Act (ASCA) requires all claims be submitted to Medicare electronically except in certain circumstances. To learn more:
Page Last Modified:
09/23/2025 04:06 PM