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U.S. Code as of:
01/19/04
Section 1320d-2. Standards for information transactions and data elements
(a) Standards to enable electronic exchange
(1) In general
The Secretary shall adopt standards for transactions, and data
elements for such transactions, to enable health information to
be exchanged electronically, that are appropriate for -
(A) the financial and administrative transactions described
in paragraph (2); and
(B) other financial and administrative transactions
determined appropriate by the Secretary, consistent with the
goals of improving the operation of the health care system and
reducing administrative costs.
(2) Transactions
The transactions referred to in paragraph (1)(A) are
transactions with respect to the following:
(A) Health claims or equivalent encounter information.
(B) Health claims attachments.
(C) Enrollment and disenrollment in a health plan.
(D) Eligibility for a health plan.
(E) Health care payment and remittance advice.
(F) Health plan premium payments.
(G) First report of injury.
(H) Health claim status.
(I) Referral certification and authorization.
(3) Accommodation of specific providers
The standards adopted by the Secretary under paragraph (1)
shall accommodate the needs of different types of health care
providers.
(b) Unique health identifiers
(1) In general
The Secretary shall adopt standards providing for a standard
unique health identifier for each individual, employer, health
plan, and health care provider for use in the health care system.
In carrying out the preceding sentence for each health plan and
health care provider, the Secretary shall take into account
multiple uses for identifiers and multiple locations and
specialty classifications for health care providers.
(2) Use of identifiers
The standards adopted under paragraph (1) shall specify the
purposes for which a unique health identifier may be used.
(c) Code sets
(1) In general
The Secretary shall adopt standards that -
(A) select code sets for appropriate data elements for the
transactions referred to in subsection (a)(1) of this section
from among the code sets that have been developed by private
and public entities; or
(B) establish code sets for such data elements if no code
sets for the data elements have been developed.
(2) Distribution
The Secretary shall establish efficient and low-cost procedures
for distribution (including electronic distribution) of code sets
and modifications made to such code sets under section 1320d-3(b)
of this title.
(d) Security standards for health information
(1) Security standards
The Secretary shall adopt security standards that -
(A) take into account -
(i) the technical capabilities of record systems used to
maintain health information;
(ii) the costs of security measures;
(iii) the need for training persons who have access to
health information;
(iv) the value of audit trails in computerized record
systems; and
(v) the needs and capabilities of small health care
providers and rural health care providers (as such providers
are defined by the Secretary); and
(B) ensure that a health care clearinghouse, if it is part of
a larger organization, has policies and security procedures
which isolate the activities of the health care clearinghouse
with respect to processing information in a manner that
prevents unauthorized access to such information by such larger
organization.
(2) Safeguards
Each person described in section 1320d-1(a) of this title who
maintains or transmits health information shall maintain
reasonable and appropriate administrative, technical, and
physical safeguards -
(A) to ensure the integrity and confidentiality of the
information;
(B) to protect against any reasonably anticipated -
(i) threats or hazards to the security or integrity of the
information; and
(ii) unauthorized uses or disclosures of the information;
and
(C) otherwise to ensure compliance with this part by the
officers and employees of such person.
(e) Electronic signature
(1) Standards
The Secretary, in coordination with the Secretary of Commerce,
shall adopt standards specifying procedures for the electronic
transmission and authentication of signatures with respect to the
transactions referred to in subsection (a)(1) of this section.
(2) Effect of compliance
Compliance with the standards adopted under paragraph (1) shall
be deemed to satisfy Federal and State statutory requirements for
written signatures with respect to the transactions referred to
in subsection (a)(1) of this section.
(f) Transfer of information among health plans
The Secretary shall adopt standards for transferring among health
plans appropriate standard data elements needed for the
coordination of benefits, the sequential processing of claims, and
other data elements for individuals who have more than one health
plan.
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