Health Care Claims or Equivalent Encounter Information for Institutional Claims

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Federally required	Cost	Test Tool Availability
Implementation Specification	ASC X12®/N005010X223 Health Care Claim: Institutional (837), May 2006 as an ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 and ASC X12N/005010X223A2 Type 1 Errata to Health Care Claim: Institutional (837), June 2010 as Type 1 Errata to an ASC X12 Standards for Electronic Data Interchange Technical Report Type 3	Final	Production	Yes	$	Yes
Implementation Specification	HL7® FHIR® Consumer Directed Payer Data Exchange (CARIN IG for BlueButton®) STU 1	Final	Production	Yes	Free	Yes
Implementation Specification	HL7 FHIR Consumer Directed Payer Data Exchange (CARIN IG for BlueButton) STU 2	Balloted Draft	Pilot	Yes	Free	Yes

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
The Administrative Simplification provisions of HIPAA apply to the adoption of electronic transaction standards and operating rules for use in the health care industry. Information about the HIPAA regulations regarding standards and operating rules can be found at https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html. Before implementation of a new version of a standard, end to end testing should be conducted with vendor systems and between trading partners to ensure changes have been accommodated. Additional information is available on testing, and the full cost on any of the X12 transactions. ASETT is the HHS compliance tool to enable testing and complaint filing for all X12 and NCPDP® transactions. For a description of the functionality of each transaction, visit the X12 website. Click on a transaction set name to toggle the display of the purpose and scope of that transaction set. The HL7 FHIR Consumer Directed Payer Data Exchange (Carin IG for BlueButton) STU 1 was recommended for use in the May 2020 CMS Interoperability and Patient Access final rule to enable the Patient Access API policy, specifically to support patients access to data held by their payers, enabling them to request data to be sent to a third party app. STU 2 of the HL7 FHIR Consumer Directed Payer Data Exchange (Carin IG for BlueButton) will include the ability to exchange dental claim information.	All covered entities and their business associates are required to comply with the HIPAA Privacy and Security Rules. Health and Human Services has partnered with the Office of the National Coordinator and the National Institutes of Standards and Technology to publish comprehensive guidance for Security specific to electronic protected health information. A self-assessment tool kit is available to support integrating privacy and security into practices.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

The Administrative Simplification provisions of HIPAA apply to the adoption of electronic transaction standards and operating rules for use in the health care industry. Information about the HIPAA regulations regarding standards and operating rules can be found at https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html.
Before implementation of a new version of a standard, end to end testing should be conducted with vendor systems and between trading partners to ensure changes have been accommodated.
Additional information is available on testing, and the full cost on any of the X12 transactions. ASETT is the HHS compliance tool to enable testing and complaint filing for all X12 and NCPDP® transactions.
For a description of the functionality of each transaction, visit the X12 website. Click on a transaction set name to toggle the display of the purpose and scope of that transaction set.
The HL7 FHIR Consumer Directed Payer Data Exchange (Carin IG for BlueButton) STU 1 was recommended for use in the May 2020 CMS Interoperability and Patient Access final rule to enable the Patient Access API policy, specifically to support patients access to data held by their payers, enabling them to request data to be sent to a third party app.
STU 2 of the HL7 FHIR Consumer Directed Payer Data Exchange (Carin IG for BlueButton) will include the ability to exchange dental claim information.

All covered entities and their business associates are required to comply with the HIPAA Privacy and Security Rules. Health and Human Services has partnered with the Office of the National Coordinator and the National Institutes of Standards and Technology to publish comprehensive guidance for Security specific to electronic protected health information. A self-assessment tool kit is available to support integrating privacy and security into practices.

Comment

Submitted by markaroberts85 on 2022-10-01

CARIN Alliance Comments on ISA

The CARIN Alliance, a multi-sector group of stakeholders requests that ONC update the Health Care Claims or Equivalent Encounter Information for Professional Claims and Institutional Claims in the ISA to include the latest information related to the HL7® FHIR® Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) Implementation Guide (IG). Please see the attached comment letter for additional details.

CARIN Alliance Comments on ISA 093022.pdf