Administrative Simplification Enforcement

The Centers for Medicare & Medicaid Services (CMS) National Standards Group (NSG), on behalf of the Department of Health and Human Services (HHS), enforces Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification requirements related to transaction standards, code sets, unique identifiers, and operating rules. HHS enforces the requirements that standardize health care electronic transactions through complaint management and compliance review programs.

Filing a Complaint

If you believe a covered entity is not complying with adopted standards or operating rules, you can file a complaint using the Administrative Simplification Enforcement and Testing Tool (ASETT).

Filing a complaint begins a multi-step process during which HHS conducts an investigation of the allegations. HHS then works with the complaint entities to resolve any issues.

Compliance Review Program

HHS conducts periodic, comprehensive reviews of randomly selected covered entities to assess their compliance. When conducting a compliance review, HHS examines administrative transactions for compliance with standards for:

• Transaction formats

• Code sets

• Unique identifiers

• Operating Rules

HHS works with covered entities that are not compliant to resolve issues and achieve compliance, commonly through Corrective Action Plans.