Existing Wording: § 162.923 Requirements for covered entities. (b) Exception for direct data entry transactions. A health care provider electing to use direct data entry offered by a health plan to conduct a transaction for which a standard has been adopted under this part must use the applicable data content and data condition requirements of the standard when conducting the transaction. The health care provider is not required to use the format requirements of the standard.

Comment:

A health care provider can seek to utilize a DDE, but that is listed as an exception to the standard. The initial HIPAA standard was for EHR/PMS to payer 278 transaction, which is not being used. In other words, this transaction IG is converting FHIR into an acceptable 278-based file format for DDE into the payer system. As a result, it does not seem to be excercising the actual standard, but rather an exception.

Summary:

The method of using the 278 does not align with the regulation.