[Federal Register: August 17, 2000 (Volume 65, Number 160)]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
45 CFR Parts 160 and 162
Health Insurance Reform: Standards for Electronic Transactions
AGENCY: Office of the Secretary, HHS.
ACTION: Final rule.
SUMMARY: This rule adopts standards for eight electronic transactions and for code sets to be used in those transactions. It also contains requirements concerning the use of these standards by health plans, health care clearinghouses, and certain health care providers.
The use of these standard transactions and code sets will improve the Medicare and Medicaid programs and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.
DATES: The effective date of this rule is October 16, 2000. The incorporation by reference of certain publications listed in this rule is approved by the Director of the Federal Register as of October 16, 2000.
FOR FURTHER INFORMATION CONTACT:
Pat Brooks, (410) 786-5318, for medical diagnosis, procedure, and clinical code sets.
Joy Glass, (410) 786-6125, for the following transactions: health claims or equivalent encounter information; health care payment and remittance advice; coordination of benefits; and health claim status.
Marilyn Abramovitz, (410) 786-5939, for the following transactions: enrollment and disenrollment in a health plan; eligibility for a health plan; health plan premium payments; and referral certification and authorization.
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