Compliance Date for Electronic Data Interchange Standards Approaches - Are You Prepared? 

September, 2002 - John M Collins

The deadline for compliance with the Health Insurance Portability and Accountability Act of 1996 final regulations regarding standards for electronic claims transactions, October 16, 2002, is quickly approaching. In general, all “covered entities” – health plans, health care clearinghouses, and health care providers who transmit health information in electronic form in connection with a standard transaction described in the regulations (such as sending health care claim or equivalent encounter information) – must comply with these standards by October 16, 2002. However, small health plans (plans with annual receipts of less than $5,000,000) have until October 16, 2003 to comply. The Administrative Simplification Compliance Act provided a one-year extension (to October 16, 2003) for those entities required to comply in 2002. In order to qualify for this extension the covered entity must submit a compliance plan to the Centers for Medicaid and Medicare Services on or before October 15, 2002. If the covered entity fails to submit a compliance plan by this date, it must be prepared to comply with the standards set forth in the regulations on October 16, 2002, if it is not a small health plan. Each health plan must also ensure that its vendors, such as your plan’s third-party administrator, are prepared to accept electronic transactions that comply with these standards. If your vendors are not ready to comply on your plan’s compliance date, your plan may need to file for an extension. Plans that file for the extension electronically will receive a confirmation number. Plans that file via U.S. mail or other carrier will only receive a confirmation of receipt if the manner in which they sent the extension provides for a return receipt. The website for the Centers for Medicaid and Medicare Services contains a model compliance plan at and instructions for completion of the plan. Covered entities can either complete the plan on-line and submit it electronically or download the plan and send the completed plan to the Centers for Medicaid and Medicare Services postmarked no later than October 15, 2002 addressed as follows: ATTENTION: Model Compliance Plans Centers for Medicare & Medicaid Services P.O. Box 8040 Baltimore, MD 21244-8040 If you have any questions regarding these regulations or need any assistance in either complying with these regulations or filing your compliance plan, please do not hesitate to contact one of us listed above.


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