Frequently Asked Questions About Electronic Transaction Standards Adopted Under HIPAA. What health care transactions are required to use the standards under this regulation?


As required by HIPAA, the Secretary of Health and Human Services is adopting standards for the following administrative and financial health care transactions:

  1. Health claims and equivalent encounter information.
  2. Enrollment and disenrollment in a health plan.
  3. Eligibility for a health plan.
  4. Health care payment and remittance advice.
  5. Health plan premium payments.
  6. Health claim status.
  7. Referral certification and authorization.
  8. Coordination of benefits.

Standards for the first report of injury and claims attachments (also required by HIPAA) will be adopted at a later date.