HIPAA Transaction and Code Sets
The HIPAA Transactions and Code Sets Rule mandates the use of electronic standards for certain administrative and financial health care transactions. Compliance with this rule was mandated for October 16, 2003.
Figure 2.1 lists the mandated HIPAA electronic transactions.
Figure 2.1 HIPAA Electronic Transactions
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Transaction No.
|
Transaction Standard |
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X12N 270/271
|
Eligibility/Benefit Inquiry and Response |
|
X12N 278
|
Referral Certification and Authorization |
|
X12N 837
|
Claims (Institutional, Professional, and Dental ) and Coordination of Benefits (COB) |
|
X12N 276/277
|
Claim Status Request and Response |
|
X12N 835
|
Payment and Remittance Advice |
|
X12N 834
|
Enrollment/Disenrollment in a Health Plan |
|
X12N 820
|
Payroll Deduction for Insurance Premiums |
|
NCPDP Telecom Std. Ver. 5.1
|
Retail Pharmacy Drug Claims, COB, Referral Certification and Authorization, Eligibility Inquiry and Response |
|
NCPDP Batch Std. Ver. 1.1
|
Retail Pharmacy Drug Claims, COB, Referral Certification and Authorization, Eligibility Inquiry and Response |
|
TBD
|
Claims Attachments |
|
TBD
|
First Report of Injury |
The MHS and the TRICARE program are now HIPAA compliant with standard transactions and code sets. Where these business functions are performed electronically, the HIPAA standards are now in use. For more information, visit the TRICARE HIPAA Web site.
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