Direct Data Entry-No Change in the 5010 Final Rule

In the August 17, 2000 Final Rule for Standards for Electronic Transactions, direct data entry was defined as “direct entry of data (for example, using dumb terminals or web browsers) that is immediately transmitted into a health plan’s computer.” [65 Federal Register 50367] An exception for direct data entry was articulated in the August 17, 2000, Final Rule: A health care provider electing to use direct data entry offered by a health plan to conduct a transaction for which a standard has been adopted under this part must use the applicable data content and data condition requirements of the standard when conducting the transaction. The health care provider is not required to use the format requirements of the standard.” [65 Federal Register 50369]

The Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Final Rules, published January 16, 2009, which adopted Versions 5010 and D.0 of the Transactions Standard, for compliance by all healthcare covered entities January 1, 2012, addressed direct data entry, but did not alter the definition and exception for use quoted above. The January 16, 2009, Final Rule provided the following response in the preamble: “One commenter requested that we address expectations related to [CFR] Section 162.925[b] regarding health plan incentives to health care providers for using direct data entry (DDE) transactions. The commenter said there are instances where health plans offer more information about eligibility and benefit information on Web sites than they do through the standard X12 270/271 transactions, which the commenter believes is an incentive for a provider to conduct a transaction using some means other than the standard transaction. The commenter requested clarification regarding the offer of more information through a non-standard transaction, even though the standard transaction contains the required amount of information. Since we [HHS] did not address this issue in the proposed rule, we [HHS] do not respond here, but may provide additional direction in a future Frequently Asked Question [FAQ] on the CMS Web site.” [74 Federal Register 3310]

Also, the HIPAA references in the HITECH provisions of the American Recovery and Reinvestment Act (ARRA) signed by President Obama on February 17, 2009, also did not further address direct data entry.

Stay tuned!

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