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The Department of Health and Human Services (“HHS”) has proposed a rule that updates retail pharmacy standards for electronic transactions adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  There is a 60-day public comment period for this rule, which closes on January 9, 2023.  This proposed rule, if finalized, would modify the currently adopted National Council for Prescription Drug Programs (“NCPDP”) Telecommunications Standard Implementation Guide (“TSIG”) and its equivalent batch standards. 

Specifically, the proposed rule would adopt TSIG version F6, and its equivalent batch standards NCPDP Batch Standard Implementation Guide, Version 15, and Batch Standard Pharmacy Subrogation Implementation Guide Version 10 (for non-Medicaid health plans).

The new standards will allow retail pharmacies with multiple locations to send one batch mode transaction that meets the F6 standard.  Among the changes from version to version are new data fields, new data segments, and new functionality.Continue Reading HHS Proposes Rule to Update Retail Pharmacy Standards for Electronic Transactions under HIPAA

CMS is again extending the enforcement discretion period for updated HIPAA ASC X12 Version 5010 (Version 5010) standard. Although CMS previously announced it would require all Medicare fee-for-service transactions to be in version 5010 format by April 1, 2012, that deadline has been extended again until July 1, 2012.

CMS is reminding Medicare providers that the enforcement discretion period for updated HIPAA ASC X12 Version 5010 (Version 5010) standard ends March 31, 2012. All Medicare fee-for-service transactions must be in version 5010 format by April 1, 2012; transactions using 4010 formatting will be returned as unprocessable. CMS reports that the “vast majority of provider…

On February 16, 2012, CMS is hosting a Special National Provider Education Call regarding Medicare fee-for-service (FFS) implementation of HIPAA Version 5010 and D.0 transaction standards. The call will focus on addressing recommendations made by the industry as well as outstanding fixes impacting the Part A and Part B Version 5010 transition.  Registration is required.

On January 25, 2012, CMS will host a National Provider Call regarding Medicare fee-for-service (FFS) implementation of HIPAA Version 5010 and D.0 transaction standards. The target audience for this call includes vendors, clearinghouses, and providers who need to make Medicare FFS-specific changes in compliance with HIPAA Version 5010 requirements. Registration is required.

CMS recently announced an enforcement discretion period for updated HIPAA ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0), and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. While the compliance date for implementation of these updated standards remains January 1, 2012, CMS will not initiate enforcement actions with respect to any HIPAA covered…

CMS has compiled resources for the health care industry as they prepare for the transitions to Version 5010 HIPAA electronic health transactions standards on January 1, 2012 and the ICD-10 for medical diagnosis and inpatient procedure coding on October 1, 2013. Most recently, CMS has released a series of “Implementation Handbooks” to assist small and medium …

On July 8, 2011, HHS published an interim final rule with comment period implementing certain administrative simplification provisions of the ACA. Specifically, the regulation adopts operating rules for two HIPAA transactions: eligibility for a health plan and health care claim status. The rule also defines the term “operating rules” and explains the role of operating rules …