May 2010 Newsletter
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA) includes an expansion of the administrative simplification requirements under HIPAA that will impact electronic transactions. Key provisions include:
- Operating rules to be adopted for all transaction standards. These rules are defined as”the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications...”
- Interim Final Rule for Claims Attachments within one year of enactment.
- Interim Final Rule for a Unique Health Plan Identifier by 10/2012.
- Interim Final Rule for Standards for First Report of Injury by 1/2014.
- Elimination of multiple companion guides
Adoption of a single, binding companion guide, including operating rules for each X12 Version 5010 transaction.
The companion guides and operating rules for the Eligibility and Claim Status transactions to be adopted by 2011 and effective 2013. - Enforcement provisions
The addition of random audits and a certification process to ensure health plans are syntactically and functionally compliant with all the standard transactions.
Starting 12/31/2013, certification statements must be filed with the Department of Health and Human Services. - Operating rules for electronic funds transfers (EFT) and health care payment and remittance advice to take effect by 1/1/2014.
- All paper versions of standardized transactions to comply with the same standards used for electronic transactions.
- Accommodating necessary changes between versions by developing a process for upgrading standards on an annual basis just as many code sets are currently updated.