News Release

HHS Proposes Standards for Electronic Health Care Attachments

HHS Secretary Mike Leavitt today proposed the adoption of standards for certain attachments to electronic health care claims, a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed standards, published today in the Federal Register, will apply to electronic transactions by covered entities to request and provide clinical information for certain types of services which are being billed by the provider to the health plan.

Covered entities will be required to use the standards when they are conducting an electronic transaction for the purpose of requesting and providing additional information for one of the six types of services.

“These HIPAA provisions make processing claims and other health care transactions much more efficient and in the long run save millions of dollars,” Secretary Leavitt said. “Adoption of these standards and the implementation of electronic medical records will allow our health care community to lead America’s efforts in improving the quality of care, avoiding errors and enhancing communication between providers.”

These electronic health care claims attachment standards have been designed to work in concert with the HIPAA Privacy Rule, published in the Federal Register on Dec. 28, 2000, as modified by changes published on Aug. 14, 2002, and the HIPAA Security Rule, published in the Federal Register on Feb. 23, 2003, as well as the HIPAA Transactions and Code Set Rule, published in the Federal Register on Aug. 17, 2000, and modified Feb. 20, 2003. The proposed standards would use much of the same terminology and definitions.

This proposed rule has a two-month comment period, which ends Nov. 23, 2005. When adopted in a final rule, the attachment standards will affect health care providers who transmit health information in electronic form in connection with a transaction covered by HIPAA, health plans, and health care clearinghouses, within two years (three years for small health plans) of the effective date of the final rule planned for 2006.

“Setting standards for electronic attachments for the health care claims is a natural step in our goal of ensuring that clinical information be available when it is needed,” Secretary Leavitt said. “These steps lead to a future in which electronic health records are complete and electronic medical record systems are beneficial.”

The proposed standards would require covered entities to use certain transactions, messaging standards and a new code set when they electronically request the additional information, and provide the information in response to the request. Six specific types of attachments are covered by this proposed rule: laboratory results, emergency department services, ambulance services, medications, clinical reports, and nine rehabilitation specialties.

The Secretary of Health and Human Services has designated the Centers for Medicare & Medicaid Services as the agency within the department to administer and enforce the transaction and code sets, identifier, and security provisions of HIPAA. The Office for Civil Rights has responsibility for administering and enforcing the Privacy Rule.