CMS Launches Review Program for HIPAA-Covered Health Plans

CMS has launched a Compliance Review Program to ensure that health plans, payers, providers, and other covered entities are complying with HIPAA Administrative Simplification rules for electronic transactions.

All HIPAA-covered health plans and other entities must comply with Administrative Simplification rules in order to reap the benefits of standardized transactions and reduced administrative costs. Transactions can include claims and encounter information, eligibility, enrollment and disenrollment, and referrals and authorizations.

In April 2019, HHS will randomly select nine HIPAA-covered entities for Compliance Reviews. HHS piloted the program in 2018 with three health plans and three clearinghouses to streamline the process.


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