HIPAA Transactions and Code Sets Rules

HIPAA Journal July 3, 2024
Steve Alder

The HIPAA transactions and code sets rules have the objective of replacing non-standard descriptions of healthcare activities with standard formats for each type of activity in order to streamline administrative processes, lower operating costs, and improve the quality of data.

During the 1970s and 1980s, an increasing number of organizations in the healthcare and health insurance industries adopted Electronic Data Interchanges (EDIs) to accelerate manual healthcare processes such as eligibility checks, treatment authorizations, and remittance advices. However, many organizations developed proprietary transaction and code set formats to describe specific healthcare activities based on the formats used for internal operations.

Consequently, prior to the passage of HIPAA, it was estimated there were up to 400 proprietary formats in use. Acknowledging this...

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