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The X12 834 EDI Enrollment Implementation Format is a standard file format in the United States for electronically exchanging health plan enrollment data between employers and health insurance carriers.
The Computer Security Act of 1987, Public Law No. 100-235 (H.R. 145), (Jan. 8, 1988), is a United States federal law enacted in 1987. It is intended to improve the security and privacy of sensitive information in federal computer systems and to establish minimally acceptable security practices for such systems.
Exchanges in the US must operate with patient consent to comply with not only the Health Insurance Portability and Accountability Act (HIPAA) and also variety of state and federal laws and regulations. This was clarified by the Office of Civil Rights in the January 2013 Final Omnibus Rule Update to HIPAA. [9]
Failure to meet these requirements may result in either limitation of future funds or termination of assistance. Specific requirements for matching, level of effort, and earmarking are unique to each federal program, and are described in the laws, regulations, and contract or grant provisions that pertain to the program. [24]
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.
Each jurisdiction can have laws, licensing bodies, and regulations that describe requirements for education and training, and define scope of practice. Governing, licensing, and law enforcement bodies are often at the sub-national (e.g. state or province) level, but national guidelines and regulations also often exist.
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