If you’re not up to speed on HIPAA’s electronic transactions and code sets rule, you’re not alone. Fifty-three percent of CMA members responding to our HIPAA survey do not understand what they need to do to transmit HIPAA-compliant claims by the October 16 deadline; 24 percent have not communicated with their software vendor or billing service about their ability to conduct electronic transactions by the deadline; and 21 percent were unaware that health plans may reject noncompliant claims after October 16.

The HIPAA transaction rule requires technical changes to billing software. To comply, claims must be made using a set of standard codes that will eliminate payer-specific local codes (some exceptions may apply to Medi-Cal). The rule requires that data be mapped to specific fields and includes data that some computer systems do not presently capture.

Unlike the HIPAA privacy rule that can be satisfied by carefully thinking about internal processes and developing policies and procedures to protect patient privacy, the transaction rule requires technical changes to the way computers transmit data to each other. Unless your practice is blessed with computer-programming staff, you are likely to need assistance from outside resources.

CMA is continually developing resources to assist members with the transition to HIPAA compliance.

• CMA has prepared sample letters physicians can send to their software vendors or billing services so that they can begin analyzing their HIPAA upgrade needs. Download these letters from the HIPAA Resource Center at CMA’s members-only website, and send them out today.
• CMA identified the top clearinghouses selected by California health plans and is surveying them for information about their services. Information from these surveys will be shared through CMA Alert.
• CMA is also surveying major health plans to learn more about their plans and resources for helping physicians become HIPAA compliant.
• CMA is developing workshops, exploring alternative resources, and working on tools to help physicians get the information they need to make smart decisions about HIPAA compliance.

If you have not done so already, please click here to complete our brief HIPAA survey at so that we can develop resources that best meet our members’ educational and informational needs.

Contact: CMA’s HIPAA Hotline, 415/882-3311 or legalinfo@cmanet.org.