Certification of Electronic Transaction Compliance for Health Plans Withdrawn

On January 2, 2014, the Secretary of Health and Human Services (the Secretary) proposed a new rule [79 FR 298] that would have required a controlling health plan (CHP) to submit information and documentation demonstrating that it is compliant with certain electronic standard transactions and operating rules adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The three electronic transactions were (i) eligibility for a health plan, (ii) health care claim status, and (iii) health care electronic funds transfers (EFT) and remittance advice. This proposed rule would have also established penalty fees for a CHP that failed to comply with the certification of compliance requirements.

The number and type of entities that would be impacted by these requirements was much greater than by previous HIPAA administrative simplification requirements. For example, many self-funded health plans that meet the HIPAA definition of a health plan would have been subject to the requirements in the proposed rule. These self-funded health plans had not been impacted by previous HIPAA administrative simplification requirements because many do not directly conduct HIPAA covered transactions, except for those mentioned above.

As of the publication date in the Federal Register, which is currently scheduled to be October 4, 2017, the proposed rule is withdrawn.