The U.S. Department of Health and Human Services (HHS) has released its final rule standardizing electronic health care transactions, as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The rule was published in the August 17, 2000, Federal Register and was also made available on the HHS Web site last week. This rule is the first of several standards mandated by the new "Administrative Simplification" part of the Social Security Act (Title XI) that was created through HIPAA (Title II, Subtitle F). The final rule establishes standards for the way in which health care entities provide electronic information concerning eligibility determinations, claims, and payments, and gives health care organizations 26 months from the final publication date to use the standard formats for electronic transactions. Small, self-administered health plans -- those with a maximum of $5 million in annual receipts -- will have three years to comply with the electronic standards. Paper claims are currently exempt from the standards.

The health care industry currently uses over 400 different formats to transmit health information. The HIPAA standards for electronic transactions will streamline the processing of health care claims, and HHS estimates that the industry will achieve a net savings of nearly $30 billion over the next 10 years as a result.

GNYHA will be providing information to its members on the new transaction set through its HIPAA workgroup meetings.