CMS Issues Final Rule on Administrative Simplification for Health Care Claims Attachments

The Centers for Medicare & Medicaid Services (CMS) has released a final rule titled Administrative Simplification: Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures, marking a significant step toward streamlining Medicare claims processing.

The rule eliminates the use of manual methods—such as fax machines and paper mail—for transmitting claims‑related supporting clinical documentation, including medical records, imaging and X‑rays, clinical notes, visit documentation, and laboratory results. In their place, the rule establishes the first‑ever Health Insurance Portability and Accountability Act (HIPAA) adopted standards for health care claims attachments, enabling the secure, electronic exchange of supporting clinical information associated with claims.

Adopted Standards

To support secure and efficient electronic exchange of claims‑related clinical documentation, the final rule adopts the following standards:

• X12 Standards (Administrative Transaction Data):
  CMS finalized the adoption of Version 6020 of the X12N 275 and the X12N 277 for claims attachments.
• Health Level Seven (HL7®) Standards (Clinical Data Integration):
  The rule adopted the HL7 clinical documentation standards for packaging clinical data, which consolidated Clinical Document Architecture (C‑CDA) and the 2022 version of the Attachments Implementation Guide (IG).

In addition, the rule establishes requirements for electronic signatures to ensure that health care claims attachment transactions are secure, authenticated, and compliant with federal standards. However, this rule did not make changes to the prior authorization documentation submission process.

Effective Date

Providers will need to adopt these HIPAA-adopted standards for their claim attachments by 2028.