HHS proposes HIPAA standards for e-health claims attachments

The Health and Human Services Department is proposing the adoption of standards for certain attachments to electronic health care claims under the Health Insurance Portability and Accountability Act.

The proposed standards would require physicians, hospitals and other 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 related to health plans processing claims.

HHS published the proposed rule in the Sept. 23 Federal Register.

“These HIPAA provisions make processing claims and other health care transactions much more efficient and, in the long run, [will] save millions of dollars,” said HHS Secretary Mike Leavitt. The proposed rule is also another step toward building electronic health records.

The rule proposes specifications from three standards-setting organizations: two X12N transactions standards from the Accredited Standards Committee for requesting and responding with information; the content and format of communicating the clinical information from Health Level 7; and specific identification of the additional information being requested and the coded answers in response from the Logical Observation Identifiers Names and Codes, whose database is housed at the Regenstrief Institute, a nonprofit housed at Indiana University.

The electronic health care claims attachment standards, which will become effective within two years of the date of the final rule in 2006, will work in conjunction with the HIPAA privacy and security rules. The proposed rule has a two-month comment period.

HHS’ Centers for Medicare and Medicaid Services administers and enforces the HIPAA transaction and code sets, identifier and security provisions of HIPAA. The Office for Civil Rights administers and enforces the privacy rule.

Six specific types of attachments are covered by the proposed rule:
  • laboratory results

  • emergency department services

  • ambulance services

  • medications

  • clinical reports, and

  • nine rehabilitation specialties.

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