Administrative Simplification Basics: Transactions

Administrative Simplification Basics Series: Transactions

Did you know that CMS Administrative Simplification includes standards for common health care administrative transactions? The standards address the content and format to be used for each of these electronic transactions:

• Claims and encounter information
• Payment and remittance advice
• Claims status
• Eligibility
• Enrollment and disenrollment
• Referrals and authorizations
• Coordination of benefits
• Premium payment

The goal is to streamline these transactions so that you spend less time on paperwork. Widespread use of standards for these transactions—where everyone uses the same language, format, and codes—can lead to substantial savings across the health care community.

Visit the transactions section of the CMS Administrative Simplification website to learn more.