THE HIPAA
TRANSACTIONS AND CODE SET REGULATIONS
The Administrative Simplification Provisions of the
Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
The HIPAA transaction and code set regulations are administered by the
Centers for Medicare & Medicaid Services and included below are the regulations and supporting documentation
released by CMS.
The Statute: The Health Insurance Portability and Accountability Act of
1996 - Relevant Portions
The Administrative Simplification Provisions of the HIPAA statute
Statutory Penalities for Noncompliance
HR 3323: Transactions and Code Set Compliance Date Delay
Legislation passed by Congress in December 2001 to extend implementation of the
HIPAA transactions and code sets regulations for one year until October 16, 2003.
The Regulations
Complete
Text of August 17, 2000 Federal Register Final Regulations on Standards for Electronic
Transactions
Effective October 16, 2000
Compliance Date is October 16, 2002 (2003 for small health plans)
View the
regulations in pdf format
Standards for Electronic Transactions: Correction - Published in Federal Register November 24, 2000
Technical and typographical errors that appeared in the final rule published in the Federal Register on August 17, 2000. (Note that text of this correction rule begins at bottom of left column).
Modifications to Standards for Electronic Transactions and Code Sets
Final rule, published February 20, 2003 in the Federal Register, modifies a number of the electronic transactions and code sets adopted as national standards under HIPAA, and eliminates the
NDC code set as the standard for all providers except retail pharmacies. It does not adopt a standard reporting drugs and biologics on non-retail
pharmacy transactions.
Final regulations in pdf format
Final regulations in html format
Corrections to Final Electronic Transactions and Code Sets Regulations
Published in the Federal Register on March 10, 2003, this document includes technical corrections to the February
20, 2003 final standards for electronic transactions and code sets.
Guidance and Interpretation
Guidance on Compliance With HIPAA Transactions and Code Sets
CMS guidance document on compliance with the HIPAA transactions and code sets after the
October 16, 2003 implementation deadline.
HIPAA Information Series for Providers on Transactions and Code Sets
Series of white papers prepared by CMS with guidance on compliance with the transactions and
code set requirements.
Implementation Guides and Data Dictionaries for Transaction Standards
Free downloads from HHS; requires registration and password.
| 
