CMS HIPAA Standards

CMS HIPAA Standards Approved

CMS HIPAA 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 Washington Publishing Company. The HIPAA-standard implementation specifications for claims, remittance advices, and claim status requests follow:

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

With the CMS implementation of the 5010 transactions, the following two transactions shall be used in the acknowledgment of the receipt of claims: ASC X12 Health Care Claim Acknowledgment (277) and ASC X12-Implementation Acknowledgment For Health Care Insurance (999).

A/B MACs, DME MACs along with the Common Electric Data Interchange (CEDI) contractor must transact versions of the institutional and professional claim (ASC X12 837 claim, institutional and professional), the remittance advice (ASC X12 835 remittance advice), the claim status request and response (ASC X12 276/277 claim status request and response), the eligibility inquiry and response (ASC X12 270/271 eligibility), and the newly adopted error handling transactions (the ASC X12 277 CA claim acknowledgment, the ASC X12 999 implementation acknowledgment and the ASC X12 TA1 interchange acknowledgment) within national standards developed by ASC X12. CEDI must transact versions of the National Council for Prescription Drug Programs (NCPDP) claims transactions. Medicare FFS supports EDI as exchanged between all covered entities and Medicare FFS contractors. This chapter provides guidance on how these relationships and the transactions generated by them shall be established, maintained and managed.

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

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