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HIPAA Administrative Simplification Requirements
Change Management Process

The first set of Rules for Transactions and Code Sets for HIPAA does not define a finish line for administrative simplification within the health care industry. Rather this is the first small increment in a process of change or evolution of how we administer health care in the United States. The health care industry will be able to leverage the standards required by HIPAA to continue to simplify the processes and costs associated with health care.

Evolutionary not Revolutionary
  • Evolutionary - Developing in small increments that accumulate to bring about significant change
  • Revolutionary - So new and different as to cause a major change in something
HIPAA Requirements will continue to evolve
Within the initial Final Rule for Transactions and Code Sets there is the requirement for eight different transactions developed by both ASC X12N and the National Council for Prescription Drug Programs (NCPDP). To accomodate the industry needs, modifications to some of the eight transactions will be federally adopted and be included in the first implementation effort. In the near future another Final Rule for attachment transactions will include standards developed by Health Level 7 (HL7). Contained within the transaction implementation guides (or specifications) there are references to many code sets, some that are internal to the standards themselves and some that are external or developed, maintained, and published by other organizations (e.g. within all of the X12N implementation guides, Appendix C identifies all of the external cods sources and the responsible maintenance organizations).  The following pages provide an overview of the change management process for the transaction standards and their internally defined code sets.