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CMS Finalizes Long-Awaited Standards for Health Care Claims Attachment Transactions
Key Takeaways
- New HIPAA regulations require standardized electronic submission of health care claims attachments and supporting documentation
- Electronic record submissions must include a digital signature that meets HL7 standards
- The compliance date is May 26, 2028, but affected entities should begin preparing now
“The 1980s called, and they want their fax machines back.” – CMS Director Dr. Mehmet Oz
On May 26, 2026, regulations went into effect that, for the first time, established HIPAA standards for documentation submitted to support electronic health care claims transactions and the digital signatures used in conjunction with them.
A Long-Awaited Change
While the health care industry has seen explosive growth in innovative treatment and technology in recent years, health care claims have lagged behind, with many entities still using fax machines or postal mail to submit the supporting documentation often required by health plans in evaluating claims.
Congress called for the implementation of electronic transaction standards for claims attachments, among other transactions, around 30 years ago with the original enactment of HIPAA and again with the enactment of the Affordable Care Act in 2010. There have been numerous delays in that implementation for various reasons, despite the fact that standards for claims themselves have been around for years, so this final rule is a long-awaited and significant development.
What the New Regulations Require
The new regulations, issued under HIPAA’s administrative simplification standards, aim to improve efficiency and enhance security by mandating the submission of documentation electronically, which is ultimately expected to save significant time and money. When payors request additional documentation to support a health care claim, affected entities will be required to adhere to standards within the Health Level 7 (HL7) framework to securely submit data like medical records, clinical notes, and diagnostic testing results.
What is HL7?
HL7 is a widely adopted set of international standards used in health care to facilitate the exchange of information. HL7 operates as a sort of universal translator for health data. If each health provider, hospital department, payor, biller, and electronic health record system speaks a different language, the HL7 framework translates all of them into a common language so that different systems and providers can understand each other and exchange data more easily. In addition, the regulations require that electronic record transmissions be authenticated via digital signatures that adhere to the Digital Signatures Guide within the HL7 framework.
Preparing for Compliance
The compliance enforcement date is May 26, 2028, but affected entities should begin planning now to implement the standards. Organizations should evaluate their current claims submission processes, technology infrastructure, and vendor capabilities to identify any changes needed to achieve compliance.
Chambliss’ health care attorneys are prepared to help our clients navigate these changes. Please contact Cal Marshall, Jennifer Vessels, or your Chambliss relationship attorney if you have questions or need additional information.
