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In July 1992, WEDI published a report that outlined the steps necessary to make electronic data interchange (EDI) a routine business practice for the health care industry by 1996. The Workgroup envisioned the entire health care industry transacting business electronically, under a nationwide set of coding and format standards for all transactions.
An 834 file contains a string of data elements, with each representing a fact, such as a subscriber’s name, hire date, etc. The entire string is called a transaction set. The 834 is used to transfer enrollment information from the sponsor of the insurance coverage, benefits, or policy to a payer.
Level III codes, also called local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions.
Under HIPAA, HIPAA-covered health plans are now required to use standardized HIPAA electronic transactions. See, 42 USC § 1320d-2 and 45 CFR Part 162. Information about this can be found in the final rule for HIPAA electronic transaction standards (74 Fed. Reg. 3296, published in the Federal Register on January 16, 2009), and on the CMS website.
The HITECH Act requires entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to report data breaches that affect 500 or more persons to the United States Department of Health and Human Services (U.S. HHS), to the news media, and to the people affected by the data breaches. [23]
National Uniform Billing Committee; Abbreviation: NUBC: Founded: 1975; 50 years ago (): Type: governing body: Purpose: To develop and maintain a single billing form and standard data set to be used nationwide by institutional, private, and public providers and payers for handling health care claims.
The Fast Healthcare Interoperability Resources (FHIR, / f aɪər /, like fire) standard is a set of rules and specifications for the secure exchange of electronic health care data. It is designed to be flexible and adaptable, so that it can be used in a wide range of settings and with different health care information systems.
NPI data is downloadable from CMS. The downloadable database was updated monthly until December 2012, and has been issued weekly since. A data structure file is available separately from CMS. [6] As of June 2024, the file download size is 947.84 MB, and the raw database file (npidata_pfile_20050523-20240512.csv) is 9.3 GB when extracted. [7]
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