The Health Insurance Portability and Accountability Act (HIPAA) was passed into law in 1996. Regulations adopted standardized electronic data interchange (EDI) transactions, code sets, and unique identifiers. The HIPAA-mandated transactions streamline the administrative data exchange reducing costs and burdens on health care organizations.
HIPAA & ACA Implementation Timeline
*Acknowledgment transactions (X12 277CA Claim Acknowledgement, X12 999 Implementation Acknowledgement, and X12 TA1 Interchange Acknowledgement) are not mandated for use under HIPAA, although they were widely used.
ACA-Mandated Operating Rules
In 2010, the Patient Protection and Affordable Care Act (ACA) expanded HIPAA’s Administrative Simplification provisions to include operating rules. The operating rules, developed by the CAQH Committee on Operating Rules for Information Exchange (CORE), add additional standardization of data exchange through business rules.
* Other CORE operating rules include Attributed Patient Roster, Benefit Enrollment, and Premium Payment.
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