42 USC 1320d-4 - Requirements

U.S Code last checked for updates: May 03, 2024

§ 1320d–4.

Requirements

(a)

Conduct of transactions by plans

(1)

In general

If a person desires to conduct a transaction referred to in section 1320d–2(a)(1) of this title with a health plan as a standard transaction—

(A)

the health plan may not refuse to conduct such transaction as a standard transaction;

(B)

the insurance plan may not delay such transaction, or otherwise adversely affect, or attempt to adversely affect, the person or the transaction on the ground that the transaction is a standard transaction; and

(C)

the information transmitted and received in connection with the transaction shall be in the form of standard data elements of health information.

(2)

Satisfaction of requirements

A health plan may satisfy the requirements under paragraph (1) by—

(A)

directly transmitting and receiving standard data elements of health information; or

(B)

submitting nonstandard data elements to a health care clearinghouse for processing into standard data elements and transmission by the health care clearinghouse, and receiving standard data elements through the health care clearinghouse.

(3)

Timetable for compliance

(b)

Compliance with standards

(1)

Initial compliance

(A)

In general

(B)

Special rule for small health plans

(2)

Compliance with modified standards

(3)

Construction

Nothing in this subsection shall be construed to prohibit any person from complying with a standard or specification by—

(A)

submitting nonstandard data elements to a health care clearinghouse for processing into standard data elements and transmission by the health care clearinghouse; or

(B)

receiving standard data elements through a health care clearinghouse.

(Aug. 14, 1935, ch. 531, title XI, § 1175, as added Pub. L. 104–191, title II, § 262(a), Aug. 21, 1996, 110 Stat. 2027.)

cite as: 42 USC 1320d-4