HIPAA Transactions and Code Sets Rule

The HIPAA Transactions and Code Set rules are meant to bring standardization in the electronic exchange of patient-identifiable health related information. On the basis of Electronic Data Interchange (EDI) standards, the transactions and code set rules permit information exchange from computer to computer without any human intervention.

In 1996, Congress, with the aim of bringing and enhancing effectiveness and efficiency in the healthcare system, introduced national standards for the electronic exchange of healthcare transactions. EDI is applicable to nine most relevant types of administrative and financial health care transactions used by payers, physicians and other providers, including claims submission, claims status reporting, referral certification and authorization, and coordination of benefits.

Complying to HIPAA Transactions and Code Sets Rule
As per HIPAA requirement, the medical data code set has to be standardized eliminating all local and proprietary codes. Complying with the code set standards is not difficult as many of the adopted code sets are already in common use. Then also, even after submitting claims, all practices are expected to be affected by the HIPAA transactions and code set standards, as the payers, health plans, and insurance plans will be converted to using the standards in order to comply with HIPAA.

Implementing HIPAA Transactions and Code Sets Rule
Implementing transactions and code set rules is a major business process reengineering which involves complex and expensive undertakings. However, transactions and code set rules are the only part of the HIPAA regulations which promise less overhead and more savings of office expense. Also, the standards offer a rapid improvement in the quality of service provided. For effective outcome of the standards, all you need to do is controlling the data output from your practice management system and send claims electronically in the standard formats.

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