All PlansAdministrativeHigh impact
The HIPAA standards, The HIPAA Electronic Transactions standard, HIPAA-compliant code sets, Implementation guides, Terms and definitions, HIPAA-related Web sites
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
We identified it
Jun 20, 2026
Summary
HIPAA Administrative Simplification standards establish national requirements for electronic healthcare transactions, including standardized formats for claims submission, eligibility verification, and remittance advice. All covered entities must adopt specific ASC X12N and NCPDP format standards for electronic transactions and use only approved medical code sets (CPT-4, HCPCS, ICD-9-CM, CDT, NDC).
Action Required
Review current electronic billing systems to ensure compliance with HIPAA transaction standards: ASC X12N 837 for professional/institutional claims, ASC X12N 270/271 for eligibility verification, ASC X12N 835 for remittance advice, and NCPDP formats for pharmacy claims. Billing team must verify all systems use only approved code sets (CPT-4, HCPCS, ICD-9-CM) and eliminate any local or proprietary codes. Contact software vendors to confirm HIPAA compliance and implementation timeline.