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2. What transactions are covered?

HIPAA requires the Secretary of Health and Human Services to adopt standards for the following 9 administrative and financial health care transactions:

1. Health claims or equivalent encounter information.
2. Health claims attachments.
3. Enrollment and disenrollment in a health plan.
4. Eligibility for a health plan.
5. Health care payment and remittance advice.
6. Health plan premium payments.
7. First report of injury.
8. Health claim status.
9. Referral certification and authorization.

HIPAA also directs the Secretary to adopt standards for unique health identifiers for:

1. Individuals.
2. Employers.
3. Health plans.
4. Health care providers.

and standards for:

1. Code sets for data elements in the transactions above.
2. Security.
3. Electronic signatures.
4. Coordination of benefits.

The Secretary is also required to submit to Congress detailed recommendations on standards to protect the privacy of individually identifiable health information.

TABLE OF CONTENTS