CMS HIPAA Compliance Audits and Federal Standards

Would you be prepared for a CMS-sponsored HIPPA compliance review audit? Beginning this year, as part of the Compliance Review Program, nine randomly selected HIPAA-covered health plans and/or clearinghouses, regardless of whether they work with Medicaid or Medicare, will participate in these annual CMS audits.

Fortunately, UHIN helps our payer members meet federal standards through our multiple solutions. For example, with our hosted eligibility, payers provide UHIN with coverage and benefit information which is utilized to create a compliant response to providers seeking eligibility information on patients. UHIN also provides claims validation at various SNIP levels. If errors occur on a submitted claim or report, UHIN can reject the claim or file on the front end, and work with the provider to correctly resubmit their claims. Both examples dramatically increase interoperability and reduce administrative burden for payers, while promoting the timely submission of accurate claims files.

As a federally-recognized standards development organization, UHIN convenes the community to help draft local standards and review national standards. These ongoing community efforts further refine HIPAA transaction standards. The Standards Committee also works to educate our community on the latest information in both local and federal standards.

If you would like more information on our EDI validation editing, or would like to learn more about the Standards Committee, please do not hesitate to contact UHIN’s Customer Service at