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Administrative Simplification Resources Toolkit (ZIP)
This toolkit (ZIP) features key Administrative Simplification resources, along with a table of contents outlining the information they contain.
Statement of Enforcement Discretion for Referral Certification and Authorization Transaction Standard
This guidance letter (PDF) announces an enforcement discretion for HIPAA covered entities that implement FHIR-based Prior Authorization APIs as described in the CMS Interoperability and Prior Authorization final rule (CMS-0057-F).
Statement of Enforcement Discretion for Referral Certification and Authorization Transaction Standard FAQs
These FAQs (PDF) respond to public comments on the National Standards Group’s (NSG) Guidance Letter announcing an enforcement discretion related to the X12 278 Standard.
Guidance on National Provider Identifier (NPI) Enumeration
This guidance letter (PDF) clarifies the prohibition at 45 CFR § 162.412(b) that a health plan may not require a health care provider that has been assigned an NPI to obtain an additional NPI.
HIMSS23: HIPAA Standard Transactions Presentation
HIMSS23: HIPAA Standard Transactions Presentation (PDF)
Slides from the HIPAA Standard Transactions presentation at HIMSS23 on April 18, 2023.
Health Care Transactions Basics (PDF) – provides an overview and background for all adopted transactions
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
Coordination of Benefits Transactions (PDF) – describes the COB transaction and provides information on the adopted standard
Claim Status Transactions (PDF) – describes the claim status inquiry and response transaction and provides information on the adopted standard and operating rules
Eligibility and Benefits Transactions (PDF) – describes the eligibility and benefits inquiry and response transaction and provides information on the adopted standard and operating rules
Code Sets – describes the purpose of code sets and provides information on Administrative Simplification code sets
Page Last Modified:
09/23/2025 12:14 PM