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Health Care Transactions Basics

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23 views

Health Care Transactions Basics

Uploaded by

ascheffler
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ABOUT ADMINISTRATIVE SIMPLIFICATION

Health Care Transactions Basics


What is a Health Care
Transaction? Administrative Simplifcation Standard
A health care transaction is an
Transactions
exchange of information between To help guide the health care industry, the
two parties to carry out financial Department of Health and Human Services (HHS) adopted
or administrative activities. When standardized implementation specifications for electronic
electronic health care transactions transactions used in the electronic exchange of health care data.
are used effectively, they: These adopted transactions include:
• Increase efficiencies in operations • Health care claim X12N 837 transaction
• Improve the quality and accuracy • Health care claim payment advice X12N 835 transaction
of information • Health care claim status request/notifcation X12N 276/277 transaction
• Reduce the overall costs to the • Eligibility, coverage, or beneft inquiry/information X12N 270/271
health care system transaction
Widespread use of Healthcare • Beneft enrollment and maintenance X12N 834 transaction
Insurance Portability and • Health care service review information X12N 278 transaction
Accountability Act of 1996 • Payment order/remittance advice X12N 820 transaction
(HIPAA) adopted transactions— HIPAA-covered entities—health plans, clearinghouses, and covered
where everyone uses the same health care providers—must use the adopted standards when
language, format, and code sets— conducting these transactions using an electronic format.
can lead to substantial savings For several of these transactions, HHS has also adopted
across the health care industry. operating rules that support the use of transactions.
To realize these benefits, however,
all organizations need to be using
the same adopted standards for
their health care transactions.
Enforcement
The National Standards Group (NSG) enforces compliance with
Administrative Simplification standards and operating rules on
behalf of the Department of Health and Human Services.
Information about enforcement, compliance, and fling complaints
can be found on the CMS website.

Visit Our Website


To find out more, visit Go.CMS.gov/AdminSimp and sign up for
Administrative Simplification Email Updates.

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