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Transaction and code set standards

The HIPAA Transactions and Code Set Standards standardize the format for electronic transactions between physicians and health plans and other entities. For example, the claims that physicians submit to payers must be in a specific format. The compliance date for the Transaction and Code Set Standards was October 16, 2003.

Submission of Electronic Medicare Claims

Although HIPAA does not require physicians to use electronic transactions, a related law, the Administrative Simplification Compliance Act, does impose such a requirement. The Administrative Simplification Compliance Act requires that all claims submitted to the Medicare program must be submitted in electronic form. The implication of this requirement is that because the claims are submitted electronically, they will also be required to comply with HIPAA. The compliance date for the requirement to submit Medicare claims electronically was October 16, 2003.

Download How to "HIPAA"--Top 10 Tips to understand the basics about the Transaction and Code Set Rules.

Learn more about the Transaction and Code Set Rules

(The following links will take you off the AMA Web site. The AMA is not responsible for the content of other Web sites.)
Visit the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) to view:

Massachusetts Medical Society article on HIPAA Electronic Transactions and Code Sets

AMA Compliance Resources

HIPAA Preparedness

AMA information on the final rule on transaction and code sets standards to comply with the Health Insurance Accountability and Portability Act.

Last updated:Mar 14, 2008
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