On June 30, 2011, the U.S. Department of Health and Human Services (DHHS) issued an interim final rule with comment period (slated for publication in the July 8 Federal Register) adopting operating rules for two HIPAA transactions: patient eligibility for coverage and health care claim status.  This interim final rule was mandated by section 1104 of the Affordable Care Act’s administrative simplification provisions, which requires the DHHS secretary to adopt new operating rules that standardize electronic health care transactions with the aim of promoting efficiency and reducing costs.

According to the interim final rule, “gaps created by the flexibility in the [HIPAA transaction] standards permit each health plan to use the transactions in very different ways, which remains an obstacle to achieve greater uniformity in the transmission of health information”. 

The two new operating rules, which largely track those developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange, a health care coalition focusing on administrative simplification, “will provide greater uniformity of information and transition formats so that physicians and other health care providers can use one type of information request for all insurers rather than being required to use multiple systems,” according to DHHS. 

Health plans, health care clearinghouses, and certain health care providers must comply with the interim final rule by January 1, 2013. Comments on the rule are due by September 6.