Alexandria, Va., August 24, 2000 - Propelled by the Accredited Standards Committee (ASC) X12, the publication of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) requires health care players to implement uniform electronic data interchange (EDI) by October 2002. The HIPAA final rule mandates the implementation of industry specifications based on the X12 standards. Mentioned throughout the rule, ASC X12 developed and contributed all the standards for EDI health care transactions except for the retail pharmacy transactions.
These standards, which must be transmitted via EDI, include the following transactions: health claims and equivalent encounter information; enrollment and disenrollment in a health plan; eligibility for a health plan; health care payment and remittance advance; health care premium payments; health claim status; referral certification and authorization and; coordination of benefits.
This industry-wide standardization is expected to eliminate more than 400 variations on administrative and financial transmissions, ultimately providing significant savings and operational efficiencies for health care providers and insurance companies. Within human resources and employee benefit management sectors of business, the implementation of the regulations is likely to improve the quality of service to the patient.
The final rule comes on the heels of the Memorandum of Understanding (MOU) signed in March by the Department of Health and Human Services (HHS), Standards Development Organizations (SDOs) and Data Content Committees (DCCs). ASC X12 is one of the six collaborative standards bodies that endorsed the MOU, developed to manage the EDI standards adopted under HIPAA and to address changes to the various transactions. This includes modifications to the standards implementation guidelines, manuals, documentation and data dictionaries, and review of requests to add new functionality or transactions to the HIPAA standards.
To learn more about the X12 transaction standards, visit ASC X12's web site at www.x12.org. Information on the HIPAA final rule can be found at the HHS Administrative Simplification web site at http://aspe.hhs.gov/admnsimp.
To obtain the HIPAA implementation guidelines for the X12 transaction standards, visit Washington Publishing Company's web site at www.wpc-edi.com. To learn more about the retail pharmacy claims, consult the National Council for Prescription Drug Programs' web site at www.ncpdp.org.
ASC X12, comprised of cross-industry representation, develops the most widely implemented EDI standards that interact with a multitude of e-commerce technologies and serves as the premier tool for integrating electronic applications. Through the X12 Committee's standards and active participation in emerging and technically relevant initiatives, ASC X12 links together multiple industries and sets the norm for a more effective exchange of information. To learn more about ASC X12, visit www.x12.org.
DISA, the association driving global e-business, is the leading provider of educational and networking forums on the booming digital marketplace. Propelling e-business initiatives, DISA also provides technical and management services to standards and XML specification development organizations, including ASC X12, the OpenTravel Alliance, the Interactive Financial Exchange Forum, the Mortgage Industry Standards Maintenance Organization, and the XML/EDI Group. DISA's affiliation with the Hotel Electronic Distribution Network Association, EC User Groups and emerging initiatives around the world facilitates an interchange of e-commerce topics hitting the marketplace. In other international arenas, DISA and ASC X12 serve as the entry point for the United States into the United Nations/Electronic Data Interchange for Administration, Commerce and Transport (UN/EDIFACT), an international standard relating to the exchange of trade goods and services.