The U.S. Department of Health and Human Services (HHS) has issued a proposed rule that would update HIPAA’s electronic transaction standards regarding some retail pharmacy transactions related to healthcare claims. The affected retail pharmacy transactions include health care claims or equivalent encounter information, eligibility for a health plan, referral certification and authorization, and coordination of benefits. Additionally, under the proposed rule, the Medicaid pharmacy subrogation transaction standard would become applicable to all health plans.
HIPAA requires that covered entities and their business associates follow certain rules to standardize the format and content of some electronic transactions. In response, HHS has adopted various regulations establishing and updating these standards, including 2009 regulations for electronic pharmacy-related transactions.
The proposed rule has three goals:
- Provide increased data exchange;
- Improve coordination of benefits; and
- Expand financial fields to avoid manual data entry.
