§1320d–1 General Requirements for Adoption of Standards

Summary

Standards adopted under this part must be followed by health plans, health care clearinghouses, and health care providers who send health information electronically for standard health transactions. The standards must aim to lower the paperwork and administrative costs of providing and paying for health care. Usually the standards should come from recognized standard-setting organizations, but the Secretary can adopt a different standard if it will greatly cut costs and is adopted through formal rulemaking. If no standard-setting group has a relevant standard, the usual requirement to use their standard does not apply and the Secretary follows the special consultation rules. Before a standard is adopted, the developer or the Secretary must consult with four named groups: the National Uniform Billing Committee (billing rules group), the National Uniform Claim Committee (claim forms group), the Workgroup for Electronic Data Interchange (electronic data rules group), and the American Dental Association. The Secretary must also write implementation specifications, protect trade secrets and confidential business information, rely on recommendations from the National Committee on Vital and Health Statistics, consult appropriate federal and state agencies and private groups, publish NCVHS recommendations in the Federal Register, and treat changes to standards the same as new standards.