Hacker News Reader

The HIPAA final rule mandates ASC X12 as the standard format for certain interactions such as eligibility and claims. It's old and somewhat clunky, but it's not terribly hard to implement. Libraries are available for most popular languages. Even if we replaced X12 with a modern format like HL7 FHIR (which is now legally allowed for some interactions such as prior authorization) that wouldn't solve the fundamental business, legal, and clinical problems.

View on HN

It’s terrible to implement at the business and industry level - the required details enclosed with the messages are wholly insufficient to properly communicate claims as well as claim payments between payers and providers. Yet nothing can be done as the law requires its usage.

Could you clarify which specific details are missing from the messages? Additional clinical documentation can be sent in 275 attachments.

The law does not specifically require X12. The law gives CMS the authority to set technical standards and they chose X12 for those transactions because there was no other practical option. But recently they have granted at least one exception to use FHIR instead.

Reply on news.ycombinator.com