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Frequently Asked Questions About ADMINISTRATIVE SIMPLIFICATION

The purposes of Administrative Simplification are to improve the efficiency and effectiveness of the health care system by standardizing the electronic data interchange of certain administrative and financial transactions while protecting the security and privacy of the transmitted information. Administrative Simplification (AS) provisions were passed into law as part of Public Law 104-191 on August 21, 1996 by the signing of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which amended title XI of the Social Security Act by adding Part C - Administrative Simplification (42 U.S.C. 1329d). This section attempts to share the current thinking regarding questions which have been raised about the interpretation and implementation of these AS provisions.

Questions (date of last update)

1. Who must comply? (12/22/97)

2. What transactions are covered? (8/4/97)

3. What transmissions must comply? (8/4/97)

4. When will the standards become effective? (2/2/98)

5. How will confidential health information be protected? (7/25/97)

6. Does the law require physicians to buy computers? (9/3/97)

7. How do the standards affect data stored in my system? (8/4/97)

8. Can health plans require changes or additions to the standard claim? (7/25/97)

9. Is the government creating a central database with everyone's health records? (7/25/97)

10. What does the law require of state Medicaid programs? (7/31/97)

11. Are the standards voluntary? (11/4/97)

12. Where are the NPRMs? What is taking so long? (4/6/98)

13. Should health plans publish companion documents that augment the information in the standard implementation guides for electronic transactions? (5/13/98)

14. Could companion documents from health plans define cases where the health plan wants particular pieces of data used or not used? (5/13/98)

15. May health plans stipulate the codes or data values they are willing to accept and process in order to simplify implementation? (5/13/98)

16. May health plans stipulate the number of loop iterations or the file sizes they are willing to accept? (5/13/98)

17. Should health plans communicate edits or actions they will perform on data elements or segments? (5/13/98)

18. What level of detail should be included in the X12N implementation guides? Would it be inappropriate for X12N to try to integrate payer-specific communications into the IGs? (5/13/98)

19. Who determines whether the implementation guides are ready for public review or use? (5/13/98)

TABLE OF CONTENTS