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Administrative Simplification Enforcement Discretion Frequently Asked Questions



The Office of Burden Reduction and Health Informatics (OBRHI) National Standards Group (NSG), on behalf of the Department of Health and Human Services (HHS), would like to share some new frequently asked questions (FAQs) [ https://www.cms.gov/files/document/statement-enforcement-discretion-referral-certification.pdf ] in response to public comments received regarding the Guidance Letter (PDF) [ https://www.cms.gov/files/document/discretion-x12-278-enforcement-guidance-letter-remediated-2024-02-28.pdf ] it released on February 28, 2024, to announce an enforcement discretion related to the X12 278 Standard.

These FAQs will help the inquirer answer the following questions:


* What is the intended purpose of the enforcement discretion?
* Who is covered under the enforcement discretion?
* How will HIPAA enforcement discretion be exercised for covered entities that do not use the adopted X12 278 standard?
* How long will the enforcement remain in place?
* Under what circumstances would the enforcement discretion permitting use of an All-FHIR-Based Prior Authorization API in lieu of the adopted X12 278 standard for prior authorization transactions not apply?
* Can a health plan require another HIPAA covered entity to use an alternative standard to the X12 278 standard for prior authorization transactions?

The enforcement discretion FAQs [ https://www.cms.gov/files/document/statement-enforcement-discretion-referral-certification.pdf ] are available on the Subregulatory Guidance Frequently Asked Questions page [ https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/subregulatory-guidance/faqs ] of the Administrative Simplification website [ https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification ].   

keep up to date

Get the latest news about Administrative Simplification [ https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/events-latest-news ]. Sign up [ https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_7834 ] for Administrative Simplification Email Updates.

Visit our website at go.cms.gov/AdminSimp [ https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification ].




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