Chapter Summary

Identifying Standard Agencies, Laws, and Regulations

• Covered entities are health plans, health clearinghouses, and healthcare providers.

• The U.S. Department of Health and Human Services (HHS) is tasked with protecting the health of Americans and providing a means to access healthcare by Americans who are least able to help themselves, containing and treating any national health emergencies, and testing and regulating food and drug supplies.

• The Centers for Medicare & Medicaid Services (CMS) is responsible for administrating Medicare and Medicaid, as well as regulating standards of electronic transactions of claims, provider, and diagnostic codes.

• Version 5010 is the most recent standard format for electronic claims transactions.