NRPM: Standards for Electronic Transactions. Collection of Information Requirements


[Please label any written comments or e-mailed comments about this section with the subject: PRA]


Under the Paperwork Reduction Act of 1995 (PRA), we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues:

  • The need for the information collection and its usefulness in carrying out the proper functions of our agency.
  • The accuracy of our estimate of the information collection burden.
  • The quality, utility, and clarity of the information to be collected.
  • Recommendations to minimize the information collection burden on the affected public, including automated collection techniques.

Subpart K - Health Claims or Equivalent Encounter Information Standard

142.1104 Requirements: Health plans.

142.1108 Requirements: Health care providers.

Subpart L - Health Care Payment and Remittance Advice

142.1204 Requirements: Health plans.

Subpart M - Coordination of Benefits

142.1304 Requirements: Health plans.

Subpart N - Health Claims Status

142.1404 Requirements: Health plans.

142.1408 Requirements: Health care providers.

Subpart O - Enrollment and Disenrollment in a Health Plan

142.1504 Requirements: Health plans.

Subpart P -Eligibility for a Health Plan

142.1604 Requirements: Health plans.

142.1608 Requirements: Health care providers.

Subpart Q - Health Plan Premium Payments

142.1704 Requirements: Health plans.

Subpart R - Referral Certification and Authorization

142.1804 Requirements: Health plans.

142.1808 Requirements: Health care providers.

Discussion: In summary, each of the sections identified above require health care plans, and/or health care providers to use any given standard proposed in this regulation for all electronically transmitted standard transactions that require it on and after the effective date given to it.

The emerging and increasing use of health care EDI standards and transactions raises the issue of the applicability of the PRA. The question arises whether a regulation that adopts an EDI standard used to exchange certain information constitutes an information collection subject to the PRA. However, for the purpose of soliciting useful public comment we provide the following burden estimates.

In particular, the initial burden on the estimated 4 million health plans and 1.2 million health care providers to modify their current computer systems software would be 10 hours/$300 per entity, for a total burden of 52 million hours/$1.56 billion. While this burden estimate may appear low, on average, we believe it to be accurate. This is based on the assumption that these and the other burden calculations associated with the HIPAA administrative simplification systems modifications may overlap. This average also takes into consideration that: (1) one or more of these standards may not be used; (2) some of the these standards may already be in use by several of the estimated entities; (3) modifications may be performed in an aggregate manner during the course of routine business and/or; (4) modifications may be made by contractors such as practice management vendors, in a single effort for a multitude of affected entities.

We solicit comment on whether the requirements to which we refer above constitute a one-time or an ongoing, usual and customary business practice as defined 5 CFR 1320.3(b)(2), the Paperwork Reduction regulations.

We invite public comment on the issues discussed above. If you comment on these information collection and recordkeeping requirements, please e-mail comments to (Attn:HCFA-0149) or mail copies directly to the following:

Health Care Financing Administration,
Office of Information Services,
Information Technology Investment Management Group,
Division of HCFA Enterprise Standards,
Room C2-26-17, 7500 Security Boulevard,
Baltimore, MD 21244-1850.
Attn: John Burke HCFA-0149.


Office of Information and Regulatory Affairs,
Office of Management and Budget,
Room 10235, New Executive Office Building,
Washington, DC 20503,
Attn: Allison Herron Eydt, HCFA Desk Officer.

VI. Response to Comments

Because of the large number of items of correspondence we normally receive on Federal Register documents published for comment, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the "DATES" section of this preamble, and, if we proceed with a subsequent document, we will respond to comments in the preamble to that document.