NRPM: Standard Health Care Provider Identifier. 2. Health care clearinghouse.


We would define “health care clearinghouse” as section 1171(2) of the Act does, but we are adding a further, clarifying sentence. The statute defines a “health care clearinghouse” as a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements. We would further explain that such an entity is one that currently receives health care transactions from health care providers and other entities, translates the data from a given format into one acceptable to the intended recipient and forwards the processed transaction to appropriate health plans and other clearinghouses, as necessary, for further action.

There are currently a number of private clearinghouses that perform these functions for health care providers. For purposes of this rule, we would consider billing services, repricing companies, community health management information systems or community health information systems, value-added networks, and switches performing these functions to be health care clearinghouses.