HHS Extends Comment Period for Proposed Rule on Health Care Attachments Standards for HIPAA Covered Entities; Comments Due April 21

Published March 24, 2023

The Department of Health and Human Services (HHS) released an extension to the comment period for the proposed rule titled "Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard".

The comment period for the proposed rule initially ended on March 21, 2023, but has been extended to April 21, 2023 by 5 p.m. ET.

(updated March 24, 2023)

The Department of Health and Human Services (HHS) has released a proposed rule that would implement standards for “health care attachments” transactions, such as medical charts, x-rays, and provider notes that document physician referrals, and office or telemedicine visits. The modifications to the adopted Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions would support both health care claims and prior authorization transactions, standards for electronic signatures to be used in conjunction with health care attachments transactions, and a modification to the standard for the referral certification and authorization transaction. The proposal is intended to make the process of submitting and adjudicating health care claims more efficient by providing structured, standardized electronic data to payers. The proposed rule would define the term “electronic signature” as broadly as possible. 

HIPAA and the Affordable Care Act require the HHS Secretary to adopt a health care claim attachment standard. HHS is proposing these new requirements on HIPAA-covered entities, which include health plans, health care clearinghouses, and health care providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards.

Health Care Attachments


Every health plan has requirements with which a health care provider must comply for the plan to authorize and pay the provider for health care services. Health plans frequently require a health care provider to submit additional information beyond the administrative data contained in a HIPAA transaction, such as medical documentation to support health care claims or referral authorizations. Typically, this additional information is needed so a health plan may make an administrative decision about payment for a covered service, or a coverage decision about a service the provider intends to render. HHS stated that providers are often forced to utilize manual processes such as physical mail, fax, or internet web portals when they respond to these requests from health plans.

The proposed standards cover three general use cases whereby a provider would submit electronic documentation to a health plan:

  • Prior Authorization: A provider must obtain a health plan’s approval for a service before it is rendered to the patient. 
  • Solicited Documents: A provider has submitted a claim for a rendered service and the health plan decides that more information is required to make a payment determination. The health plan requests more information from the provider and the provider responds.
  • Unsolicited Documents: A provider submits a claims attachment along with their initial submission of a health care claim transaction for a service they have rendered. This usually occurs when a provider is in a full claims review program with the health plan or the health plan’s payment policies require documents with each claim submission for service.
The proposed rule is titled, "Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard."
Comments are due March 21, 2023.

Additional Information


(posted December 21, 2022)