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Standards for Electronic Transactions and Code Sets

Modifications to Standards for
Electronic Transactions and Code Sets
(as published in the Federal Register,
February 20, 2003)

This final rule responds to public comments received and finalizes provisions applicable to electronic data transaction standards from two related proposed rules published in the May 31, 2002 Federal Register. It also adopts proposed modifications to implementation specifications for health care entities and others. In addition, it adopts modifications to implementation specifications for several electronic transaction standards that were omitted from the May 31, 2002 proposed rules.

The Administrative Simplification Compliance Act delays the compliance date for transactions and code sets to October 16, 2003 for those who submitted compliance plans. This extension mandates that transactions testing begins by April 16, 2003.

Full Document:

Text format

Adobe PDF

ASC X12N Implementation Guides Addenda available through the Washington Publishing Co.

PREAMBLE:

Summary

I. Background
II. Provisions of the Proposed Rules
III. Analysis of, and Responses to, Comments on the Proposed Rules

A. Compliance Date
B. Responses to Comments on CMS-0003-P (67 FR 38044)
C. Proposal to Adopt Modifications to the Standards Adopted in the Transactions Rule
D. Composition of the Addenda
E. Proposed Modifications to the Standards
F. Comments on the Modifications Included in the Addenda
G. Transaction Standard for Health Care Claims or Equivalent Encounter Information
H. Transaction Standard for Eligibility for a Health Plan
I. Transaction Standard for Referral Certification and Authorization
J. Transaction Standard for Health Care Claim Status
K. Transaction Standard for Enrollment and Disenrollment in a Health Plan
L. Transaction Standard for Health Care Claim Payment/Advice
M. Transaction Standard for Health Care Premium Payments

IV. Waiver of Proposed Rulemaking
V. Collection of Information Requirements
VI. Regulatory Impact Statement

REGULATION TEXT:

PART 162—ADMINISTRATIVE REQUIREMENTS

1. Authority citation for part 162
2. Section 162.900 revisions
3. Section 162.920 revisions
4. Section 162.1002 amendments
5. Section 162.1102 revisions
6. Section 162.1202 revisions
7. Section 162.1302 revisions
8. Section 162.1402 revisions
9. Section 162.1502 revisions
10. Section 162.1602 revisions
11. Section 162.1702 revisions
12. Section 162.1802 revisions

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