Health Information Management

HIPAA prompts CMS to alter data requirements

HIPAA Weekly Advisor, April 5, 2004

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The Centers for Medicare & Medicaid Services told providers and fiscal intermediaries that changes to claims-processing requirements will go into effect for all claims submitted on or after July 6, "Health Data Management" reported March 29.

Medicare will now require the following changes:

* Claims must have certain data elements not currently required for claim adjudication, but required by HIPAA.

* Claims including data allowed by Medicare but prohibited by HIPAA will be rejected.

* Medicare will begin to edit certain data not only for syntax, but for content, and this could result in claim rejections.



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