HHS issues interim rule for e-data interchange

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An interim final rule for electronic transactions, published in the Federal Register July 8, would standardize electronic data interchange (EDI) in an effort to streamline financial and administrative transactions, according to the U.S. Department of Health and Human Services (HHS).

The administrative simplification provisions of the Patient Protection and Affordable Care Act (PPACA) direct the HHS secretary to adopt a single set of operating rules for each transaction with the goal of creating as much uniformity in the implementation of the electronic standards as possible, according to the interim rule.

Although both the payor and provider communities have used EDI to process financial and administrative transactions, standards lack cohesion. However, “in general, transaction standards adopted under HIPAA enable EDI through a common interchange structure, thus minimizing the industry’s reliance on multiple formats,” the rule stated.

The interim final rule adopts operating rules for electronic transactions under HIPAA:

  • Eligibility for a health plan; and
  • Healthcare claim status.

It also defines operating rules and their role in relation to the adopted transaction standards, according to the agency. The transaction standards adopted under HIPAA enable EDI through a common interchange structure, thus minimizing the industry’s reliance on multiple formats.

Standards significantly decrease administrative burden on covered entities by creating greater uniformity in data exchange, and reduce the amount of paper forms needed for transmitting data. "However, gaps created by the flexibility in the standards permit each health plan to use the transactions in very different ways, which remains an obstacle to achieving greater healthcare industry administrative simplification," according to the rule.

The interim final rule cited gaps including performance and system availability, connectivity and transportation of information, and security and authentication, among others.

“Operating rules, in turn, attempt to define the rights and responsibilities of all parties, security requirements, transmission formats, response times, liabilities, exception processing, error resolution and more, in order to facilitate successful interoperability between data systems of different entities,” the interim final rule stated.

The rule also adopts many of the Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange rules, according to HHS.

Click here to see the interim final rule. Comments will be accepted for 60 days from the date of publication in the Federal Register.

The compliance date for this regulation is Jan. 1, 2013.