HIPAA Resources

This section contains resource information for the public about the Health Insurance Portability and Accountability Act of 1996 as it relates to the pharmacy industry.

ASC X12 Transactions for information on the ASC X12 270/271, 835, 837, and other transactions.

See also NCPDP guidance on the use of the ASC X12 transactions in pharmacy industry.

Health and Human Services HIPAA information - Program memorandums, outreach documents, frequently asked questions, and schedules for educational sessions.

Final Rule Information for Pharmacy

Provided by NCPDP as a service, but readers should consult a copy of the rules and corrections and determine their business needs accordingly. This document will be updated, as new information is known. Last Updated: 08/2014. HIPAA Current Final Rule Information As It Relates to the Pharmacy Industry. Please see important implementation information about the Quantity Prescribed field.


The Secretary of Health and Human Services designated NCPDP as one of the Designated Standard Maintenance Organizations (DSMOs). These organizations maintain standards for health care transactions adopted by the Secretary, and receive and process requests for adopting a new standard or modifying an adopted standard.
The DSMO website is www.hipaa-dsmo.org
Understanding the HIPAA Processes.

Streamlining HIPAA

Since the passage of the HIPAA regulation, the three standards development organizations (SDOs) named in HIPAA - ASC X12, HL7, and NCPDP have worked with the Office of E-Health Standards and Services (OESS) to propose a process of naming new versions of standards under HIPAA that is more timely and efficient for the industry. The SDOs testified to the National Committee on Vital and Health Statistics (NCVHS) in December 2005 and October 2006 and presented this paper with discussion of the current problems in the process and a proposal for the future. NCVHS discussed with HHS who noted they are constrained by their interpretation of the Administrative Procedures Act. Modifications to this process would require regulatory changes. HHS was able to streamline to create Interim Final Rules where Notice of Proposed Rule Making (NPRM) are not required.

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