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11. Are the standards voluntary?

For health care providers, transactions submitted electronically must follow the standards.

For health plans, the standards are mandatory. If a person (such as a provider or employer) chooses to conduct a transaction electronically with a health plan, the health plan may not refuse a standard transaction and may not delay or otherwise adversely affect the transaction (Section 1175(a)(1)). The law specifies monetary penalties for non-compliance.

On October 22, 1997, Representative Hobson clarified these requirements for health plans. He said:

I want to make it clear that, although voluntary standardization was considered in the past, it was judged to be unworkable in the real world and is not a part of the law today for that reason. ... The intent of the law is that all electronic transactions for which standards are specific must be conducted according to the standards.
(Congressional Record, p. E2065).

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