The health reform bill awaiting President Obama's signature includes language to significantly revamp the HIPAA transaction standards.

The bill also has significant new administrative simplification provisions. These include mandates for the Department of Health and Human Services to develop the long-delayed unique health plan identifier, and electronic funds transfer and claims attachments standards.

The bill additionally requires HHS to seek public input and consider whether to standardize the application form for insurance enrollment, as well as worker's compensation transactions, and automobile insurance-related health care transactions.

Further, HHS is mandated to consider "whether there could be greater transparency and consistency of methodologies and processes used to establish claim edits used by health plans," and whether plans should be required to publish their timeliness of payment rules.

The bill requires HHS to receive input on whether revisions should be made to the crosswalk between ICD-9 and ICD-10 that is on the Centers for Medicare and Medicaid Services' Web site. "Any revised crosswalk shall be treated as a code set for which a standard has been adopted by the Secretary for purposes of section 1173(c)(1)(B) of the Social Security Act (42 U.S.C. 1320d-2(c)(1)(B))," according to the bill. That section is the HIPAA administrative simplification provisions.

To tighten the existing HIPAA transaction standards, the bill mandates use of "operating rules" that payer advocacy organization CAQH has championed to standardize the HIPAA standards. The goal is to make financial and administrative transactions as easy to conduct as an ATM transaction.

The rules for eligibility and claims status transactions would allow for the use of a machine-readable card, under the bill. Further, the set of operating rules for electronic funds transfers and remittance advice transactions "shall allow for automated reconciliation of the electronic payment with the remittance advice."

The legislation carries compliance deadlines from 2013 to 2016 for various transactions. Insurers would have to certify to the Department of Health and Human Services that they comply with the operating rules.

Text of H.R. 3590 is available at The administrative simplification provisions are under Sec. 1104 and Sec. 10109.

--Joseph Goedert


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