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Background Information
In 1996, Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) which required the Secretary of the Department of Health and Human Services (HSS) to adopt standards for electronic data interchange within the healthcare industry in the U. S.
Transactions included were: the electronic transmittal of health claims or equivalent encounter information; health claim attachments; enrollment and dis-enrollment from a health plan; eligibility for a health plan; healthcare payment and remittance advice; health plan premium payment; health claims status; and referral certification and authorization.
In addition, the secretary also was required to adopt a number of supporting standards for code sets and classification systems for the data elements of the transactions identified, such as: CPT codes, CPT modifiers and ICD-9 codes, privacy and security standards, and unique identifiers for employers, health plans and healthcare providers.
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