HIPAA Transaction Standards

HIPAA Transaction Standards as Designated by CMS

HIPAA transaction standards shall be supported by the A/B MACs, DME MACs, CEDI or other contractors if designated by CMS for the electronic data with Medicare providers/submitters/receivers/COB trading partners.

ASC X12 Technical Report 3s (TR3s) for mandated HIPAA transactions may be purchased from the official Washington Publishing Company website. The HIPAA-standard implementation specifications for claims, remittance advices, and claim status requests follow:

  • ASC X12 Standards for Electronic Data Interchange Technical Report Type 3- Health Care Claim: Professional (837)
  • ASC X12 Standards for Electronic Data Interchange Technical Report Type 3- Health Care Claim: Institutional (837).
  • ASC X12 Standards for Electronic Data Interchange Technical Report Type 3- Health Care Claim Payment/Advice (835).
  • ASC X12 Standards for Electronic Data Interchange Technical Report Type 3- Health Care Claim Status Request and Response (276/277).
  • Telecommunication Standard Implementation Guide and equivalent Batch Standard Implementation Guide, National Council for Prescription Drug Programs.

To learn more about HIPAA EDI syandards and become a certified EDI Professional please visit our course schedule page.

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