Transactions covered under new HIPAA rule

The final "Transactions and Code Sets" rule from the Health Insurance Portability and Accountability Act, published in August by the U.S. Department of Health and Human Services, requires health plans and providers to use designated transaction standards when transmitting data electronically. The transactions covered under the rule are:

• Health claims or equivalent encounter information
• Eligibility for a health plan
• Referral certification and authorization
• Health care claim status
• Enrollment and disenrollment in a health plan
• Health care payment and remittance advice
• Health plan premium payments
• Coordination of benefits