HIPAA Transactions and Code Sets

The Health Insurance Portability and Accountability Act (HIPAA) requires that certain electronic health care transactions be conducted using mandated electronic standards and formats.  These transactions include claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, and premium payment. HIPAA also requires that specific code sets be used to identify diagnoses and procedures in health care transactions. The code sets that apply to physicians are ICD, CPT and HCPCS. Finally, HIPAA mandates the use of identifier codes such as the National Provider Identifier (NPI). Click here for official information from CMS.