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Transaction and code set standards
The HIPAA Transactions and Code Set Standards standardize the format for electronic transactions between physicians and health plans and other entities. For example, the claims that physicians submit to payers must be in a specific format. The compliance date for the Transaction and Code Set Standards was October 16, 2003.
Submission of electronic Medicare claims
Although HIPAA does not require physicians to use electronic transactions, a related law, the Administrative Simplification Compliance Act, does impose such a requirement. The Administrative Simplification Compliance Act requires that all claims submitted to the Medicare program must be submitted in electronic form. The implication of this requirement is that because the claims are submitted electronically, they will also be required to comply with HIPAA. The compliance date for the requirement to submit Medicare claims electronically was October 16, 2003.
Download How to "HIPAA"--Top 10 tips to understand the basics about the Transaction and Code Set Rules.
Learn more about the Transaction and Code Set Rules
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Massachusetts Medical Society article on HIPAA Electronic Transactions and Code Sets
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