January 17, 2023

Two Decades Later, CMS Releases Draft Rule on Claims Attachments

More than twenty years after the original HIPAA Transactions and Code Sets Final Rule established mandatory standards to simplify and expand the use of electronic data interchange (EDI) to transmit administrative healthcare messages electronically between providers and payers, CMS has finally released the Electronic Claims Attachment standard promised in that regulation.

CMS cartoon

More specifically, the draft regulation provides specifications for documents necessary to support both healthcare claims and prior authorizations. Also included are specifications for electronic signatures needed in association with these transmissions, and a version upgrade for some existing transactions already in use.

At a tidy 31 pages, the title is exuberantly verbose: Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard. The first pages of the narrative are both a history lesson and a reference library tracing the development and evolution of the industry wide collaboration known as Administrative Simplification or, to participants, portmanteaued as "AdminSimp." I say "library," because as the authors, in explaining how we got to this point, generously footnoted -- and linked -- the key documents that mapped that progress.

For example:

9 CAQH CORE Report on Attachments: ‘‘A Bridge to a Fully Automated Future to Share Medical Documentation’’, CAQH CORE, May 9, 2019: https://www.caqh.org/about/press-release/caqh-core-study-reveals-five-opportunities-increase-electronic-exchange-medical.

That press release then points to the white paper: CAQH CORE Report on Attachments: A Bridge to a Fully Automated Future to Share Medical Documentation.

The comment period on the new regulation is open until 5 p.m. on March 21, 2023.  CMS will be hosting two informational calls with Q&A over the next few weeks. I'll be attending the one on January 25.

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