Thursday, December 14, 2023

Spotlight: New Administrative Simplification Exceptions Process Resources

centers for medicare and medicaid services

NSG Publishes New Exceptions Process Infographic & Webpage

The Centers for Medicare & Medicaid Services' (CMS) National Standards Group (NSG) would like to spotlight the new Administrative Simplification Exceptions Process webpage, which serves as a resource for requesting an exception to the standards for transactions and code sets under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

As detailed in 45 CFR 162.940, a HIPAA covered entity may request an exception from the use of a standard transaction from the Secretary to test a proposed modification to that standard to see if it improves the efficiency and effectiveness of the health care system by leading to cost reductions or improvements in benefits from electronic transactions.

Those requesting an exception must elaborate on:

Why the modification would be beneficial;
How they will test the standard;
What modifications they are proposing; and
Which of their trading partners agreed to participate in the testing stage.

Note: Organizations have 90 days from test completion to submit modification improvement results and a cost-benefit analysis to NSG.

For More Information

Further information on the exceptions process can be found in the Exceptions Process infographic, which overviews the 10 principles that guide the exceptions process. Additional instructions may be found in this Guidance Letter on the CMS website.

To submit your exception request or if you have questions about this guidance, send inquiries to AdministrativeSimplificationException@cms.hhs.gov with the subject line: HIPAA Transaction Exception Question.