Other Resources related to HIPAA and ACA

The National Committee on Vital and Health Statistics (NCVHS) - Established by Congress to serve as an advisory body to the Department of Health and Human Services. NCVHS serves as a national forum and conducts public hearings with the long-term goal of improving the compatibility of private sector, state, and federal health information systems while assuring the confidentiality of the information collected. NCVHS fosters collaboration to accelerate a consensus-driven process for the development of key data standards and privacy issues.

In 1996, the Committee was restructured to meet expanded responsibilities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Affordable Care Act of 2010 further defined and expanded the Committee's advisory role. See the link in the “Related Links Outside CMS” section below.

Accredited Standards Committee (ASC X12) - An ANSI accredited standards organization responsible for the development and maintenance of electronic data interchange (EDI) standards for many industries. The "X12N" or insurance section of ASC X12 handles the EDI for the health insurance industry's administrative transactions. Under HIPAA, X12 standards have been adopted for most of the transactions between health plans and providers. See the link in the "Related Links Outside CMS" section below.

CAQH CORE – The Council for Affordable Quality Healthcare (CAQH) – A nonprofit alliance of health plans, networks and trade associations collaborating on initiatives seeking to simplify healthcare administration. The Committee on Operating Rules for Information Exchange (CORE) is a multi-stakeholder initiative by CAQH to create, disseminate, and maintain operating rules that enable healthcare providers to quickly and securely obtain reliable healthcare information and decrease the amount of time and resources providers spend verifying administrative information at the point of care. See the link in the "Related Links Outside CMS" section below.

NACHA, the Electronic Payments Association – an industry trade association and administrator of the Automated Clearing House (ACH) Network. NACHA brings together payments system stakeholders to encourage the efficient utilization of the ACH Network and support innovation in the use of the Network. NACHA also has responsibilities for NACHA Operating Rules for the network of financial institutions that facilitate electronic transfers of funds and remittance advice. See the link in the "Related Links Outside CMS" section below.

National Council for Prescription Drug Programs (NCPDP) – This organization creates and promotes standards for the transfer of data to and from the pharmacy services sector of the healthcare industry. Under HIPAA, NCPDP standards were adopted for several retail pharmacy transactions. See the link in the “Related Links Outside CMS” section below.

Designated Standard Maintenance Organizations (DSMO) - Those organizations designated by the Secretary of the Department of Health and Human Services to maintain the standards adopted under the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification. The current organizations named as DSMOs' are: Accredited Standards Committee X12, Dental Content Committee of the American Dental Association, Health Level Seven (HL7), National Council for Prescription Drug Programs (NCPDP), National Uniform Billing Committee (NUBC), and National Uniform Claim Committee (NUCC). See the links in the “Related Links Outside CMS” section below.

X12 TR3 Reports - These X12 Reports (previously referred to as Implementation Guides) are the specific technical instructions for implementing each of the adopted standards. The TR3 Reports are prepared by ASCX12 (as the standard maintainer) and are made available to the public for a modest fee. To obtain the HIPAA TR3 Reports, see the link in the “Related Links Outside CMS” section below.

Workgroup for Electronic Data Interchange (WEDI) – This is a national organization representing the entire health care industry. Their mission is to provide education, foster support for the adoption of electronic commerce, and provide opportunities for collaboration and exchange. WEDI was named in HIPAA as an advisory organization to the Secretary. See the link in the “Related Links Outside CMS” section below.

Strategic National Implementation Process (SNIP) – Sponsored by the Workgroup for Electronic Data Interchange (WEDI), this is a collaborative healthcare process for the implementation of the HIPAA standards. This website includes white papers on transactions, security, identifiers, and privacy. See the link in the “Related Links Outside CMS” section below.

Medicare Electronic Data Interchange (EDI) - This is the official Medicare website that contains important information about how providers can communicate electronically with the Medicare Program. This website contains EDI formats and instructions, transaction mapping information, statistics, FAQs about Medicare EDI, and other valuable EDI data. See the link in the “Related Links Inside CMS” section below.

HIPAA Health Insurance Reform - Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Visit this website to find out about pre-existing conditions and portability of health insurance coverage. See the link in the “Related Links Inside CMS” section below.