Health Care Eligibility Benefit Inquiry and Response

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Implementation Specification	ASC X12®N/005010X279 Health Care Eligibility Benefit Inquiry and Response (270/271), April 2008 as an ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 and ASC X12N/005010X279A1 Type 1 Errata to Health Care Eligibility Inquiry and Response (270/271), June 2010 as Type 1 Errata to an ASC X12 Standards for Electronic Data Interchange Technical Report Type 3	Final	Production		Yes	$	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. Readers can find information about requirements for covered entities and their business associates and enforcement from this link. This standard and the transaction were adopted under the Health Insurance Portability Act of 1996 (HIPAA) to increase efficiency in the health care system by reducing the use of paper and increasing the exchange of health care information electronically. This version was adopted in 2009 and mandatory use was required in January 2012. 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 transactions. The HL7 FHIR Implementation Specifications are for use building APIs to support interoperability to support ASTP, HHS and CMS priorities.	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. Readers can find information about requirements for covered entities and their business associates and enforcement from this link.
This standard and the transaction were adopted under the Health Insurance Portability Act of 1996 (HIPAA) to increase efficiency in the health care system by reducing the use of paper and increasing the exchange of health care information electronically. This version was adopted in 2009 and mandatory use was required in January 2012.
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 transactions.
The HL7 FHIR Implementation Specifications are for use building APIs to support interoperability to support ASTP, HHS and CMS priorities.

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 shellyspiro on 2023-10-02

Pharmacy HIT Collaborative (PHIT) comment

PHIT supports NCPDP’s recommendation to add NCPDP Real-Time Prescription Benefit Standard Version 12 to the implementation specification.

Submitted by pwilson@ncpdp.org on 2021-09-29

NCPDP Comments

Add the following:

Type-Implementation Specification

Standard Implementation/Specification- NCPDP Real-Time Prescription Benefit Standard Version 12

Standards Process Maturity – Final

Implementation Maturity – Production

Adoption Level – 1

Federally required – No

Cost - $

Test Tool Availability – No

Submitted by pwilson@ncpdp.org on 2020-11-07

NCPDP Comment

Add the following: