Health Insurance Reform: Standards for Electronic Transactions. Comments and Responses on Effective Dates and Compliance Dates of Modifications


Comment: Some commenters believed 180 days may not always be enough time to implement a revised standard.

Response: The statute states that the Secretary must permit no “fewer” than 180 days for implementation after adopting a revised standard (i.e., a modification). Depending on the nature of the revision, the minimum time frame of 180 days could be longer. This time frame does not apply to the maintenance of medical code sets and external code sets. The compliance date will be specified by the code set maintaining organization responsible for maintenance changes to that code set.

We will clarify the terms modification and maintenance. In the transactions context, when a change is substantial enough to justify publication of a new version of an implementation specification, this change will be considered to be a modification. Such a change must be adopted by the Secretary through regulation. Maintenance is the activities necessary to support the use of a standard, including technical corrections to an implementation specification, and enhancements, additions, or deletions to a data code set. These changes could be non-substantive or error correction. Public comment and notification is required as part of the normal, ANSI- accredited standards development process, but regulatory action would not be required for maintenance as we have defined it. For example, this final rule adopts the ASC X12N 278 - Health Care Services Review--Request for Review and Response, Version 4010, May 2000 as the standard for the referral certification and authorization transaction. Error corrections or addendums to Version 4010, May 2000, would constitute maintenance to this standard and there would be no regulatory action. Changes requiring a new version, or an updated edition of Version 4010 (for example, moving from Version 4010, May 2000 to Version 4010, October 2001) would constitute a modification to this standard and would be adopted through regulatory action.