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Defense Health Agency

"On October 1, 2013, the Department of Defense established the Defense Health Agency (DHA) to manage the activities of the Military Health System. These activities include those previously managed by TRICARE Management Activity (TMA), which was disestablished on the same date. During the next several months, all TMA websites will change to reflect the new DHA. We appreciate your patience during this transition."

HIPAA and ACA Regulatory Information

Electronic Transactions and Operating Rules
Code Sets
Identifiers
Claims Attachments
Regulatory Activity Under Development

Regulatory Information

To view the regulatory status of HHS’ initiatives, please click here.

Electronic Transactions

Title of HIPAA Notice of Proposed Rule Making or Final Rule

Description

Date Published

NPRM

Final Rule

45 CFR Part 142: Standards for Electronic Transactions; National Standard Health Care Provider Identifier

Proposes standards for electronic transactions and code sets

May 7, 1998

NPRM

 

45 CFR Parts 160 and 162: Standards for Electronic Transactions; Announcement of DSMOs

Adopts standards for electronic transactions and code sets

August 17, 2000

 

Final Rule

Administrative Simplification Compliance Act

Enacted to ensure compliance with the standards of the Social Security Act.

December 27, 2001

 

Act

45 CFR Part 162: Modifications to Standards for Electronic Transactions and Code Sets

Proposes modifications to previously adopted retail pharmacy standards

May 31, 2002

NPRM

 

42 CFR Part 162: Modifications to Transactions and Code Set Standards for Electronic Transactions

Proposes modifications to previously adopted electronic transaction standards

May 31, 2002

NPRM

 

45 CFR Part 162: Modifications to Electronic Data Transaction Standards and Code Sets

Adopts modifications to previously adopted transaction standards (combines two related proposed rules)

February 20, 2003

 

Final Rule

45 CFR Part 162: Modifications to Electronic Data Transaction Standards and Code Sets; Corrections

Makes corrections to rule document 03–3876

March 10, 2003

 

Corrections

45 CFR Part 162: Modifications to HIPAA Electronic Transactions and Code Sets; Proposed Rule

Proposes updated versions of the standards for electronic transactions

August 22, 2008

NPRM

 

45 CFR Part 162: Modifications HIPAA Electronic Transaction Standards

Adopts updated versions of HIPAA electronic transactions

January 16, 2009

 

Final Rule

45 CFR Parts 160 and 162: Adoption of Standards for Health Care Electronic Funds Transfers (EFT) and Remittance Advice (ERA)

Adopts standards for Health Care EFT and ERA under HIPAA

January 10, 2012

 

Interim Final Rule with Comment

Operating Rules for Electronic Transactions

Title of HIPAA Notice of Proposed Rule Making or Final Rule

Description

Date Published

NPRM

Final Rule

45 CFR Parts 160 and 162: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions

Adopts operating rules for two HIPAA transactions (eligibility for a health plan and health care claims status)

July 8, 2011

 

Interim Final Rule

45 CFR Part 162: Adoption of Operating Rules for Health Care Electronic Funds Transfer (EFT) and Remittance Advice Transactions

Adopts operating rules for health care EFT and remittance advice transactions

August 10, 2012

 

Interim Final Rule with Comment


Code Sets

Title of HIPAA Notice of Proposed Rule Making or Final Rule

Description

Date Published

NPRM

Final Rule

45 CFR Parts 160 and 162: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS; Proposed Rule

Proposes modifications to two medical data code set standards

August 22, 2008

NPRM

 

45 CFR Parts 160 and 162: Modification to Medical Data Code Set Standards To Adopt ICD–10

Adopts modifications to two previously adopted data code set standards

January 16, 2009

 

Final Rule

45 CFR Part 162: Adoption of a Standard for Unique Health Plan Identifier; Addition to the NPI Requirements; and a Change to the Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets.

Proposes the adoption of standards for a national unique health plan identifier (HPID), and other entity identifier (OEID); expands requirements for NPI; and proposes change to the compliance date for ICD-10.

April 17, 2012

NPRM

 

45 CFR Part 162: Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10 Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets.

Changes the compliance date for International Classification of Diseases (ICD-10) to October 1, 2014. Adopts the standard for a national unique HPID and establishes requirements for the implementation of the HPID. Adopts the data element that will serve as an OEID. Specifies additional National Provider Identifier (NPI) requirements.

September 5, 2012

 

Final Rule

Identifiers

Title of HIPAA Notice of Proposed Rule Making or Final Rule

Description

Date Published

NPRM

Final Rule

45 CFR Part 142: National Standard Employer Identifier

Proposes a standard for a national employer identifier

June 16, 1998

NPRM

 

45 CFR Parts 160 and 162: Standard Unique Employer Identifier

Establishes a standard for a unique employer identifier

May 31, 2002

 

Final Rule

45 CFR Part 142: National Standard Health Care Provider Identifier

Proposes a standard for a national health care provider identifier

May 7, 1998

NPRM

 

45 CFR Part 162: Standard Unique Health Identifier for Health Care Providers

Establishes the standard for a unique health for health care providers.

January 23, 2004

 

Final Rule

45 CFR Part 162: Adoption of a Standard for Unique Health Plan Identifier; Addition to the NPI Requirements; and a Change to the Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets

Proposes the adoption of standards for a national unique health plan identifier (HPID), and other entity identifier (OEID); expands requirements for NPI; and proposes change to the compliance date for ICD-10.

April 17, 2012

NPRM

 

45 CFR Part 162: Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10 Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets

Adopts the standard for a national unique HPID and establishes requirements for the implementation of the HPID. Adopts the data element that will serve as an OEID. Specifies additional National Provider Identifier (NPI) requirements. Changes the compliance date for International Classification of Diseases (ICD-10) to October 1, 2014.

September 5, 2012

 

Final Rule

Claims Attachments

Title of HIPAA Notice of Proposed Rule Making or Final Rule

Description

Date Published

NPRM

Final Rule

45 CFR Part 162: Standards for Electronic Health Care Claims Attachments

Proposes standards for electronically requesting and supplying information

September 23, 2005

NPRM

 

First Report of Injury Transaction

 

N/A

Not Yet Published

Not Yet Final

Regulatory Activity Under Development

ACA Regulatory Activity

Publication Date Specified by ACA

Effective Date Specified by ACA

Regulatory Status

Health Plan Certification for EFT, Eligibility, Claim Status and Claim Payment / Remittance Advice

Date not specified

Effective no later than December 31, 2013

Under development

Health Plan Certification for Health Claim, Plan Enrollment / Disenrollment, Plan Premium Payment, Referral Certification / Authorization, and Claim Attachments

Date not specified

Effective no later than December 31, 2015

Under development

Operating Rules on Health Claim, Plan Enrollment / Disenrollment, Plan Premium Payment, and Referral Certification / Authorization

Adopt no later than July 1, 2014

Effective no later than January 1, 2016

Under development

Claim Attachment Standard and Operating Rules

Adopt Final Rule no later than January 1, 2014

Effective no later than January 1, 2016

Under development

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